Metastatic Melanoma Death Rates by Anatomic Site After Proton Beam Irradiation for Uveal Melanoma

Li, Wenjun; Gragoudas, Evangelos S.; Egan, Kathleen M.

doi:10.1001/archopht.118.8.1066

Cited by 45 publications

(26 citation statements)

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“…The postbrachytherapy follow up included A-scan and B-scan ultrasonography and a clinical examination (including metastatic evaluation) 3 months after the surgery and every 6.6 (0.3) (mean (SE)) months thereafter (a total of 1001 examinations). Each patient was examined on average 5.6 times (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Thirty three of the 147 patients died during the…”

Section: Resultsmentioning

confidence: 99%

“…8 9 Thus, it is important to define clinical factors predictive of metastatic spread. Such unfavourable prognostic parameters include a larger tumour diameter, 10 a faster growing tumour, 11 presence of extrascleral growth, tumour margin location anterior to the equator of the eye, 12 ciliary body involvement, 13 older age, 10 male sex, 10 tumour induced glaucoma, 14 and specific microvascular patterns 10 15 which can be assessed clinically either by confocal indocyanine green angiography [16][17][18] or ultrasound backscatter parameters. 19 We have previously shown that, following brachytherapy, larger tumours shrink significantly faster than smaller ones.…”

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confidence: 99%

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Post-brachytherapy initial tumour regression rate correlates with metastatic spread in posterior uveal melanoma

Kaiserman

Anteby²,

Chowers³

et al. 2004

British Journal of Ophthalmology

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Aim: To confirm the prognostic value of post-brachytherapy initial tumour regression rate in posterior uveal melanoma. Methods: A prospective, comparative, observational cohort study was carried out on 147 eyes (147 patients) with choroidal melanoma (mean age 61 years) treated with Ru-106 brachytherapy. Observation procedure: Patients were followed clinically and ultrasonically every 6.7 (SD 0.3) months (1001 examinations). On average each patient was examined 5.8 times (mean follow up 9.6 (3.7) years). The echographic parameters included tumour base size, height, internal reflectivity, regularity, vascularity, and extrascleral extension. The clinical follow up included ocular examination and periodic metastatic screening (liver function tests and liver imaging). Main outcome measures were risk of liver metastasis in correlation with the post-brachytherapy initial tumour regression rate. Results: At brachytherapy the mean tumour height was 5.2 mm (range 2.2-11.8 mm). After brachytherapy 142 tumours (96.6%) responded by a decrease in height. The initial height regression rate was 6.1% (0.8%) per month in patients who later developed metastasis v 4.3% (0.4%) per month in those who did not. Tumours higher than 6 mm, tumours with an internal reflectivity smaller than 50%, and tumours with an initial rate of height regression larger than 0.7 mm/month (10% per month) had higher 5 year melanoma related mortality. Kaplan-Meier survival analysis and the multivariate Cox proportional hazards model showed a significant role for tumour height and initial tumour regression rate on patients' survival. Conclusion: This study confirms that post-brachytherapy initial tumour regression rate has a prognostic value.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Post-brachytherapy initial tumour regression rate correlates with metastatic spread in posterior uveal melanoma

Kaiserman

Anteby²,

Chowers³

et al. 2004

British Journal of Ophthalmology

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“…As in proton therapy, single fractions in the range 14 to 16 Gy are used to treat ocular melanoma [e.g., see ref. 35], we chose to examine the effects on cells of a single acute dose of 20 Gy of proton beams. To obtain comparable effects with gamma, 40 Gy had to be used.…”

Section: Manymentioning

confidence: 99%

Radiation effects on soluble metabolites in cultured HeLa cells examined by 1H MRS: Changes in concentration of glutathione and of lipid catabolites induced by gamma rays and proton beams

et al. 2001

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SUMMARY Cultured HeLa cells were irradiated with a single acute dose of either gamma rays (40 Gy) or low-energy proton beams (20 Gy). 1H magnetic resonance spectra of intact cells harvested at different times after irradiation and of the correspondent perchloric acid (PCA) extracts prepared at different times after irradiation were run. Selected signals from glutathione and lactate were examined with the aim of investigating effects of irradiation on antioxidative stores and on mitochondrial activity. An increase of signal intensity of glutathione (GSH) takes place at 15 and 24 hr after irradiation, while a decrease of its signal intensity, accompanied by an increase of that of free glutamate, starts appearing 48 hr after irradiation. Lactate signal increases 48 hr after irradiation. Signals from lipid catabolites were also examined to explore their sensitivity in predicting the response to radiotherapy. Intensity ratios of signals of glycerophosphorylcholine and choline to that of phosphorylcholine increase with time after irradiation. Irradiating cells with gamma rays or proton beams at half a dose produces effects comparable to the metabolic variations presented here. The present experiments allow more insight into the complex pattern of the changes of GSH by irradiation and indicate that magnetic resonance spectroscopy signals from GSH, glutamate, lactate, and lipid catabolites are affected by irradiation. Finally, these data represent a first indication that the relative biological efficiency for some metabolic damage of low-energy proton beams with respect to gamma rays can reach a value of 2.

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“…In our study, 48% of the patients had a tumor height above 8 mm or a basal diameter above 16 mm (COMS size large). Another important factor is that most of our tumors were located anterior to the equator, and 35% had involvement of the ciliary body, which is a well-known predictor of poor prognosis [16,18,19,20]. …”

Section: Discussionmentioning

confidence: 99%

Outcomes of Proton Beam Radiotherapy for Large Non-Peripapillary Choroidal and Ciliary Body Melanoma at TRIUMF and the BC Cancer Agency

Weber

Paton

et al. 2015

Ocul Oncol Pathol

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Background and Purpose: To report outcomes and toxicity after proton beam radiotherapy for non-peripapillary choroidal and ciliary body melanoma considered unsuitable for other eye-sparing therapies. Materials and Methods: An existing database of 77 patients with non-peripapillary tumors treated at TRIUMF, Canada, including patient, tumor, and treatment characteristics, was updated with ocular complications and follow-up status from chart reviews. Results: Most of the patients had large tumors: 61% were T3/T4 tumors (AJCC classification), while 48% were large by the Collaborative Ocular Melanoma Study classification. The median thickness was 7.1 mm, and the ciliary body was involved in 35%. After 5 and 10 years, the actuarial ocular tumor control rate was 85 and 85%, metastasis-free survival was 72 and 57%, overall survival was 77 and 63%, the enucleation rate was 22 and 22%, and complete blindness was found in 38 and 38%, respectively. On univariate analysis, patients with ciliary body involvement had significantly worse metastasis-free survival and overall survival rates compared to patients without ciliary body involvement (p < 0.001). Conclusions: Proton therapy for large anteriorly located tumors resulted in acceptable ocular tumor control and survival rates. The risk of blindness and severe toxicity requiring enucleation was low, and a substantial proportion of patients maintained useful vision.

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Metastatic Melanoma Death Rates by Anatomic Site After Proton Beam Irradiation for Uveal Melanoma

Cited by 45 publications

References 47 publications

Post-brachytherapy initial tumour regression rate correlates with metastatic spread in posterior uveal melanoma

Post-brachytherapy initial tumour regression rate correlates with metastatic spread in posterior uveal melanoma

Radiation effects on soluble metabolites in cultured HeLa cells examined by 1H MRS: Changes in concentration of glutathione and of lipid catabolites induced by gamma rays and proton beams

Outcomes of Proton Beam Radiotherapy for Large Non-Peripapillary Choroidal and Ciliary Body Melanoma at TRIUMF and the BC Cancer Agency

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