Hypofractionated stereotactic photon radiotherapy of choroidal melanoma: 20-year experience

Eibenberger, Katharina; Dunavoelgyi, Roman; Gleiß, Andreas; Sedova, Aleksandra; Georg, Dietmar; Poetter, Richard; Dieckmann, Karin; Zehetmayer, Martin

doi:10.1080/0284186x.2020.1820572

Cited by 9 publications

(9 citation statements)

References 46 publications

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“…With mature follow-up, 5-year MFS in this small cohort is 88% which is within expectation for T1-T2 CM [14]. FFLP in our cohort was acceptable at 85% at 5 years, although lower than >90%, which is expected after treatment with ablative dose fractionation regimens [1, 2]. The confidence intervals are wide in this small study, but a reduction in FFLP is not unexpected, given the EQD reduction.…”

Section: Discussionsupporting

confidence: 67%

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Is It Possible to Preserve Vision without Compromising Metastases-Free Survival by Use of Fully Fractionated Stereotactic Radiotherapy for Posterior Choroidal Melanoma?

Phillips,

Youssef,

Bressel

et al. 2024

Ocul Oncol Pathol

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Introduction: Stereotactic radiotherapy (SRT) is used for choroidal melanoma (CM) abutting the optic nerve. Visual acuity (VA) deterioration to ≤6/60 is common. We report a pilot study of reduced-dose SRT using 2 Gy/day, aiming to preserve vision without compromising survival. Method: 60 Gy SRT was delivered in 30 fractions over 6 weeks. Liver metastasis surveillance was annual ultrasound. The primary endpoint was 5-year metastasis-free survival (5yMFS). Secondary endpoints were 2-year freedom from local progression (2yFFLP), VA, enucleation rate, and radiation toxicity. Results: Twenty adults aged ≤70 years with T1-T2M0 CM without diabetes mellitus were enrolled. Median follow-up was 5.1 years. About 85% and 90% of tumours were ≤3 mm of the macula and optic disc, respectively. Median tumour height was 2.2 mm (range 1.0–4.4 mm), and median basal diameter was 8.2 mm (range: 4.3–15.0 mm). 5yMFS was 88% (95% CI: 61–97), and the 2yFFLP rate was 90% (95%: CI 66–97). There were three enucleations for disease progression. Final VA in retained eyes was ≥6/7.5 in 6 (30%), 6/9 to 6/12 in 5 (25%), 6/15 to 6/48 in 2 (10%), and ≤6/60 in 4 (20%) eyes. Retinopathy was the main cause of vision loss besides tumour progression. Conclusion: Meaningful vision was preserved 5 years after SRT, despite high-risk tumour locations for vision loss. 2yFFLP and 5yMFS were acceptable. This dose fractionation warrants further investigation.

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Section: Discussionsupporting

confidence: 67%

“…These regimens use large fractions which are ablative for tumour and for normal tissues. Local tumour control in the eye is >90%, but deterioration of visual acuity (VA) to <6/60 is expected when the treatment volume includes the ON [2].…”

Section: Introductionmentioning

confidence: 99%

Is It Possible to Preserve Vision without Compromising Metastases-Free Survival by Use of Fully Fractionated Stereotactic Radiotherapy for Posterior Choroidal Melanoma?

Phillips,

Youssef,

Bressel

et al. 2024

Ocul Oncol Pathol

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“…However, ocular complications such as cataract, glaucoma, maculopathy, and optic neuropathy require prompt attention (26). Mashayekhi et al reported that most cases of atrophic retinal holes in the TTT-treated area occurred within 6 months after treatment, while retinal atrophy was much less prominent in patients treated with plaque radiotherapy or stereotactic hypofractionated radiotherapy (27,28). Heat-induced vitreous changes in TTT may lead to vitreoretinal traction or retinal atrophy, which may in turn explain the formation of a retinal hole (27).…”

Section: Discussionmentioning

confidence: 99%

“…observed an atrophic MH in close proximity to a melanoma after plaque radiotherapy ( 12 ). More than 50% of patients in one study cohort suffered late-onset radiation retinopathy 5 years after stereotactic hypofractionated radiotherapy ( 28 ). Another study found that the distance from the fovea to the tumor was the primary determinant of maculopathy in patients undergoing radiotherapy ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…Limited information is available on the treatment of MH and vitreous hemorrhage in eyes with choroidal melanoma. Hypofractionated stereotactic radiotherapy with 50–70 Gy in five fractions or plaque brachytherapy has recently proven sufficient to preserve the eyeball and achieve excellent local tumor control in patients with choroidal melanoma ( 28 , 30 ). Among these 11 cases we reviewed, two cases did not explicitly state whether a metastasis occurred and one case was unclear whether the macular hole developed before or after radiation treatment, but was lost to follow-up and metastatic disease was presumed.…”

Section: Discussionmentioning

confidence: 99%

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Macular hole and vitreous hemorrhage subsequent to stereotactic hypofractionated radiotherapy for choroidal melanoma: A case report and review of the literature

2022

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Choroidal melanoma is the leading primary intraocular tumor with potentially fatal outcomes in adults. The coexistence of choroidal melanoma and a macular hole is extremely rare, and treatment strategies and information on the prognosis of associated complications are currently lacking. We report the first case of choroidal melanoma complicated with a macular hole and vitreous hemorrhage after stereotactic hypofractionated radiotherapy in Japan, and review the relevant literature in relation to the possible mechanisms, treatment strategies, and outcomes. An 83-year-old male with choroidal melanoma was treated with stereotactic hypofractionated radiotherapy in January 2021. Five months later, a full-thickness macular hole developed, followed by an acute massive vitreous hemorrhage about 2 weeks later. Following confirmation of tumor regression, the patient underwent a pars plana vitrectomy and internal limiting membrane peeling. The macular hole was closed postoperatively and the patient’s best-corrected visual acuity improved to 20/125. There was no evidence of intraocular tumor dissemination or distant metastases during follow-up. A systematic literature search only identified 10 previous cases of choroidal melanoma with a macular hole in eight reports worldwide, mainly in females. Macular edema may be the primary cause of macular hole formation in these cases. Most patients who underwent vitrectomy for complications after tumor regression achieved a good prognosis. The development of a macular hole is a rare complication associated with choroidal melanoma. Anterior-posterior traction of posterior vitreous detachment and secondary macular edema may have contributed to the formation of the macular hole in the current case.

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External Beam Radiotherapy in the Management of Uveal Melanoma

Yilmaz,

Sari,

Zorlu

et al. 2024

Curr. Treat. Options in Oncol.

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Opinion statementUveal melanoma is the most common primary ocular tumor in adults. With the evidence demonstrating that episcleral plaque brachytherapy (EPB) has similar survival rates as enucleation in the Collaborative Ocular Melanoma Study (COMS), eye-sparing treatments have come to the fore today. External radiotherapy techniques (proton beam radiotherapy and stereotactic radiosurgery/fractionated stereotactic radiosurgery) are an important treatment option for globe-sparing treatments. There are no prospective randomized trials comparing these techniques; however, retrospective series, meta-analyses, and reviews indicate that these EPB and external radiotherapy techniques are equal. With this review, we aimed to examine the external radiotherapy techniques used in the treatment of uveal melanoma in detail with reference to the current literature.

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Hypofractionated stereotactic photon radiotherapy of choroidal melanoma: 20-year experience

Cited by 9 publications

References 46 publications

Is It Possible to Preserve Vision without Compromising Metastases-Free Survival by Use of Fully Fractionated Stereotactic Radiotherapy for Posterior Choroidal Melanoma?

Is It Possible to Preserve Vision without Compromising Metastases-Free Survival by Use of Fully Fractionated Stereotactic Radiotherapy for Posterior Choroidal Melanoma?

Macular hole and vitreous hemorrhage subsequent to stereotactic hypofractionated radiotherapy for choroidal melanoma: A case report and review of the literature

External Beam Radiotherapy in the Management of Uveal Melanoma

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