Long-term Results of Proton Beam Irradiated Uveal Melanomas

Gragoudas, Evangelos S.; Seddon, Johanna M.; Egan, Kathleen M.; Glynn, Robert J.; Munzenrider, John E.; Austin-Seymour, Mary; Goitein, Michael; Verhey, Lynn; Urie, Marsha; Koehler, Andreas

doi:10.1016/s0161-6420(87)33456-6

Cited by 206 publications

(83 citation statements)

References 22 publications

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“…Long term local control rates of 95% and greater have been reported by Castro et al 1 and Gragoudas et al 2 As of December 2002, over 3000 uveal melanoma patients have been treated at MGH with proton beam radiotherapy ͑PBRT͒. 5,6 The 5 and 15 yr local control rates of 97% and 95%, respectively, [6][7][8][9] and overall survival rate of 80% were reported, which is comparable to the survival rates reported for enucleation.…”

Section: Introductionsupporting

confidence: 59%

“…[1][2][3][4] Charged particle beams travel through tissue in nearly straight lines with minimum multiple scattering. The deposition of energy increases along the path of the charged particle ending with a sharp maximum, known as the Bragg peak, at the end of the particle range.…”

Section: Introductionmentioning

confidence: 99%

“…These modeling problems are often discovered by a high value of 2 and a disagreement between the surgeon's and the computer model's clip-to-limbus distances. In these cases, fundus images and 3D T2 FSE MRI images help to accurately delineate the tumor.…”

Section: Introductionmentioning

confidence: 99%

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Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

et al. 2010

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Purpose:The purpose of this study is to evaluate a novel approach for treatment planning using digital fundus image fusion in EYEPLAN for proton beam radiation therapy ͑PBRT͒ planning for ocular melanoma. The authors used a prototype version of EYEPLAN software, which allows for digital registration of high-resolution fundus photographs. The authors examined the improvement in tumor localization by replanning with the addition of fundus photo superimposition in patients with macular area tumors. Methods:The new version of EYEPLAN ͑v3.05͒ software allows for the registration of fundus photographs as a background image. This is then used in conjunction with clinical examination, tantalum marker clips, surgeon's mapping, and ultrasound to draw the tumor contour accurately. In order to determine if the fundus image superimposition helps in tumor delineation and treatment planning, the authors identified 79 patients with choroidal melanoma in the macular location that were treated with PBRT. All patients were treated to a dose of 56 GyE in four fractions. The authors reviewed and replanned all 79 macular melanoma cases with superimposition of pretreatment and post-treatment fundus imaging in the new EYEPLAN software. For patients with no local failure, the authors analyzed whether fundus photograph fusion accurately depicted and confirmed tumor volumes as outlined in the original treatment plan. For patients with local failure, the authors determined whether the addition of the fundus photograph might have benefited in terms of more accurate tumor volume delineation. Results: The mean follow-up of patients was 33.6Ϯ 23 months. Tumor growth was seen in six eyes of the 79 macular lesions. All six patients were marginal failures or tumor miss in the region of dose fall-off, including one patient with both in-field recurrence as well as marginal. Among the six recurrences, three were managed by enucleation and one underwent retreatment with proton therapy. Three patients developed distant metastasis and all three patients have since died. The replanning of six patients with their original fundus photograph superimposed showed that in four cases, the treatment field adequately covered the tumor volume. In the other two patients, the overlaid fundus photographs indicated the area of marginal miss. The replanning with the fundus photograph showed improved tumor coverage in these two macular lesions. For the remaining patients without local failure, replanning with fundus photograph superimposition confirmed the tumor volume as drawn in the original treatment plan. Conclusions: Local control was excellent in patients receiving 56 GyE of PBRT for uveal melanomas in the macular region, which traditionally can be more difficult to control. Posterior lesions are better defined with the additional use of fundus image since they can be difficult to mark surgically. In one-third of treatment failing patients, the superposition of the fundus photograph would have clearly allowed improved localization of tumor. The current practice s...

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Section: Introductionsupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

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Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

et al. 2010

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“…Since 1986, partial ocular decompression was routinely performed, either before the dissection of the scleral flap by three port vitrectomy (WSF), or after preparation of the flap, via a single sclerotomy and without infusion (BED). The deep sclera and choroid were divided some [3][4][5] used in conjunction with Cox's proportional local resection was 50 years (SD 13-3; range hazards model to identify those factors influenc-19-78). A small minority of patients were known ing event rates most profoundly.…”

Section: Surgical Techniquementioning

confidence: 99%

Predictive factors of visual outcome after local resection of choroidal melanoma.

Damato

Paul

Foulds

1993

British Journal of Ophthalmology

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“…1,3,5 No biopsies confirming the malignant nature of the lesion were performed in this series of iris lesions, but the majority of patients nevertheless presented documented growth of a tumour arising on a pre-existing lesion, while all other patients presented a tumour whose initial clinical characteristics were highly suggestive of the diagnosis in agreement with the majority of authors, 2,3,9 and according to the criteria defined above (essentially size). Conservative management by irradiation was therefore proposed on this body of evidence, by analogy with conservative radiotherapy [10][11][12][13][14][15][16][17] performed for ciliary and choroidal melanomas, in order to avoid the metastasis and preserve a functional eye. Proton therapy is a modality of conformal radiotherapy, which uses a proton beam whose ballistic properties allow localised delivery of energy to the target volume.…”

Section: Discussionmentioning

confidence: 99%