Local tumor control after 106Ru brachytherapy of choroidal melanoma

Damato, Bertil; Patel, Imran; Campbell, Ian; Mayles, Helen; Errington, R.D.

doi:10.1016/j.ijrobp.2005.02.017

Cited by 138 publications

(113 citation statements)

References 25 publications

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“…Although based on the COMS recommendation [21] tumors, up to 10 mm can be treated with 125 I brachy therapy, published studies from European countries [14,22,23] indicate that 106 Ru radioactive plaques is a choice of treatment for uveal melanomas with tumor height of 5.4 to 7 mm because of its limited depth of penetration. Therefore, the cut-off point of 7 mm was considered for thick tumor implication and inclusion criterion in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Predictors of enucleation, tumor recurrence, and poor visual acuity in 51 patients with thick choroidal melanoma (7 mm ≤ thickness < 11 mm) after 106 Ru brachytherapy (poor visual acuity was defined as VA less than or equal to 20/200) indirect tumoricidal effects of radiation through obliterating tumor blood supply can justify lower doses to apex even when the tumor is very thick, and the apex of tumor will receive radiation less than the recommended dose [15,16,34]. Compatible with this theory, some authors [22] have recommended a minimal radiation dose of 300-400 Gy to the sclera for development of choroidal atrophy. Our results showed 82.4% globe preservation with an average 106 Ru radiation dose of 71 Gy to the apex.…”

Section: Discussionmentioning

confidence: 99%

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Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Naseripour¹,

Jaberi²,

Sedaghat³

et al. 2016

jcb

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Purpose: To evaluate the outcomes of ruthenium-106 ( 106 Ru) brachytherapy in terms of radiation parameters in patients with thick uveal melanomas.Material and methods: Medical records of 51 patients with thick (thickness ≥ 7 mm and < 11 mm) uveal melanoma treated with 106 Ru brachytherapy during a ten-year period were reviewed. Radiation parameters, tumor regression, best corrected visual acuity (BCVA), and treatment-related complications were assessed.Results: Fifty one eyes of 51 consecutive patients including 25 men and 26 women with a mean age of 50.5 ± 15.2 years were enrolled. Patients were followed for 36.1 ± 26.5 months (mean ± SD). Mean radiation dose to tumor apex and to sclera were 71 (± 19.2) Gy and 1269 (± 168.2) Gy. Radiation dose rates to tumor apex and to sclera were 0.37 (± 0.14) Gy/h and 6.44 (± 1.50) Gy/h. Globe preservation was achieved in 82.4%. Preoperative mean tumor thickness of 8.1 (± 0.9) mm decreased to 4.5 (± 1.6) mm, 3.4 (± 1.4) mm, and 3.0 (± 1.46) mm at 12, 24, and 48 months after brachytherapy (p = 0.03). Four eyes that did not show regression after 6 months of brachytherapy were enucleated. Secondary enucleation was performed in 5 eyes because of tumor recurrence or neovascular glaucoma. Tumor recurrence was evident in 6 (11.8%) patients. Mean Log MAR (magnification requirement) visual acuity declined from 0.75 (± 0.63) to 0.94 (± 0.5) (p = 0.04). Best corrected visual acuity of 20/200 or worse was recorded in 37% of the patients at the time of diagnosis and 61.7% of the patients at last exam (p = 0.04). Non-proliferative and proliferative radiation-induced retinopathy was observed in 20 and 7 eyes.Conclusions: Thick uveal melanomas are amenable to 106 Ru brachytherapy with less than recommended apex radiation dose and dose rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Naseripour¹,

Jaberi²,

Sedaghat³

et al. 2016

jcb

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“…They found that clinically significant dose reduction to normal tissues was feasible. Damato et al 39,40,42 advocate eccentric positioning of ruthenium plaques in an effort to reduce radiation dose to the fovea and optic nerve when treating posteriorly located choroidal melanomas. With this technique, the posterior plaque edge is aligned with the posterior tumour margin, relying on side-scatter radiation to treat any lateral tumour extension (Figure 4a).…”

Section: Radiation Optic Neuropathymentioning

confidence: 99%

Effects of radiotherapy on uveal melanomas and adjacent tissues

Groenewald

Konstantinidis

Damato

2012

Eye

117

103

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“…Audits performed by Russo et al and Damato et al show good rates of visual conservation, with low recurrence rates. [28][29][30] Proton beam radiotherapy The Clatterbridge Centre for Oncology is one of only a dozen or so centres around the world providing proton beam radiotherapy for ocular tumours, and the only facility of its kind in the United Kingdom, which is why the author moved from Glasgow to Liverpool in 1993. Proton beams are highly collimated and their destructive ionising radiation peaks at the depth where the charged particles stop travelling (ie, the 'Bragg peak').…”

Section: Radiotherapymentioning

confidence: 99%

Progress in the management of patients with uveal melanoma. The 2012 Ashton Lecture

Damato

2012

Eye

139

100

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Uveal melanomas are diverse in their clinical features and behaviour. More than 90% involve the choroid, the remainder being confined to the ciliary body and iris. Most patients experience visual loss and more than a third require enucleation, in some cases because of pain. Diagnosis is based on slitlamp biomicroscopy and/or ophthalmoscopy, with ultrasonography, autofluorescence photography, and/or biopsy in selected cases. Conservation of the eye with useful vision has improved with advances in brachytherapy, proton beam radiotherapy, endoresection, exoresection, transpupillary thermotherapy, and photodynamic therapy. Despite ocular treatment, almost 50% of patients develop metastatic disease, which occurs almost exclusively in patients whose tumour shows chromosome 3 loss and/or class 2 gene expression profile. When the tumour shows such lethal genetic changes, the survival time depends on the anatomical stage and the histological grade of malignancy. Prognostication has improved as a result of progress in multivariate analysis including all the major risk factors. Screening for metastases is more sensitive as a consequence of advances in liver scanning with magnetic resonance imaging and other methods. More patients with metastases are living longer, benefiting from therapies such as: partial hepatectomy; radiofrequency ablation; ipilumumab immunotherapy; selective internal radiotherapy; intra-hepatic chemotherapy, possibly with isolated liver perfusion; and systemic chemotherapy. There is scope for improvement in the detection of uveal melanoma so as to maximise any opportunities for conserving the eye and vision, as well as preventing metastatic spread. Patient management has been enhanced by the formation of multidisciplinary teams in specialised ocular oncology centres.

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Local tumor control after 106Ru brachytherapy of choroidal melanoma

Cited by 138 publications

References 25 publications

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Effects of radiotherapy on uveal melanomas and adjacent tissues

Progress in the management of patients with uveal melanoma. The 2012 Ashton Lecture

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