Proton Beam Therapy Leads to Excellent Local Control Rates in Choroidal Melanoma in the Intermediate Fundus Zone

Schönfeld, Shideh; Cordini, Dino; Riechardt, Aline I.; Seibel, Ira; Willerding, G; Bechrakis, Nikolaos E.; Moser, Lutz; Joussen, Antonia M.

doi:10.1016/j.ajo.2014.08.016

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…Consistently, some authors detected retinal areas with higher density of photoreceptors to be more prone to vascular survival and homeostatic function of constitutive VEGF and to the presence of a more abundant VEGF reservoir [ 31 ]. As a confirmation, Schönfeld S et al [ 26 ] analysing only equatorially located tumours, found little difference in terms of enucleation and NVG rate despite great differences in tumour dimensions between the group undergoing ER and controls. Optic disc and ciliary body involvement represent risk factors for TTS and enucleation after secondary VR surgery in some of the analysed studies.…”

Section: Resultsmentioning

confidence: 82%

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Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

Romano

Catania

et al. 2021

IJMS

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Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.

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Section: Resultsmentioning

confidence: 82%

“…Schönfeld et al [ 26 ] published a retrospective report of equatorial choroidal melanoma following PBT, 71% of whom underwent ER as prevention for TTS. Criteria for ER were poorly defined, with indications including large sized tumours with thickness ≥ 6 mm.…”

Section: Resultsmentioning

confidence: 99%

Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

Romano

Catania

et al. 2021

IJMS

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“…Many studies describe visual outcomes after PBR of UM, according to tumoral volume [10] or according to involvement of the fovea and/or optic disc [5,6,18,19]. Visual acuity is generally preserved in patients with smaller UM located further from the posterior pole [6,18,19,20,21]. However, our study is the first which focuses specifically on visual outcomes of T1UM treated by PBR according to the proximity of the tumor to visually important structures.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Visual Outcomes for Small Uveal Melanoma Staged T1 Treated by Proton Beam Radiotherapy

Toutée

Angi

Dureau

et al. 2019

Cancers

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There is increasing evidence of the survival benefit of treating uveal melanoma in an early stage, however it is important to discuss with the patient the associated risk of visual loss. We investigated visual outcomes for uveal melanomas staged T1 (T1UM) treated by proton beam radiotherapy (PBR) as a function of their distance to fovea-optic disc. This retrospective study included a cohort of 424 patients with T1UM treated with PBR between 1991 and 2010 with at least a 5-year follow-up. Visual acuity (VA) was analyzed for patients with posterior edge of tumor located at ≥3 mm (GSup3) or <3 mm (GInf3) from fovea-optic disc. The mean follow-up duration was 122 months, no tumor recurrence was observed. The mean baseline and final VA were 20/25 and 20/32 for GSup3 (n = 75), and 20/40 and 20/80 for GInf3 (n = 317) respectively. The frequency of a 20/200 or greater visual conservation was 93.2%(CI95%:87.7–99.1) and 60.1%(CI95%:54.9–65.9) for GSup3 and GInf3 respectively. This difference between groups was statistically significant (p < 0.001). The risk factors for significant VA loss (less than 20/200) were GInf3 location (p < 0.001), tumor touching optic disc (p = 0.04), initial VA inferior to 20/40 (p < 0.001), documented growth (p = 0.002), and age greater than 60 years (p < 0.001). In summary, PBR for T1UM yields excellent tumor control and good long-term visual outcomes for tumors located ≥3 mm from fovea-optic disc.

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“…Um die Nebenwirkungen durch massiven Tumorzerfall nach Bestrahlung zu begrenzen, wird die bereits bestrahlte Tumormasse chirurgisch entfernt. Die transsklerale Tumorresektion wird nur in wenigen Zentren durchgeführt, da spezielle chirurgische Fertigkeiten und die Anästhesie in Hypotension notwendig sind [3,[5][6][7].…”

Section: Hintergrundunclassified

“…Es wurden 3 Visusstufen unterschieden (gut, mittel und niedrig) nach Schönfeld [5]. Vor Protonenbestrahlung war der Visus bei 68 % der Patienten gut (Snellen 1,25-0,4 oder -0,1-0,4 logMAR), bei 27 % mittel (Snellen 0,32-0,125 oder 0,5-0,9 logMAR) und bei 5 % niedrig (Snellen ≤0,1 oder ≥1 logMAR) (n = 139).…”

Section: Visusverlaufunclassified

Zehn Jahre multimodale Therapie uvealer Melanome an der Universitätsaugenklinik Innsbruck

Rauchegger

Blatsios

Haas

et al. 2019

Spektrum Augenheilkd.

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Proton Beam Therapy Leads to Excellent Local Control Rates in Choroidal Melanoma in the Intermediate Fundus Zone

Cited by 6 publications

References 14 publications

Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

Long-Term Visual Outcomes for Small Uveal Melanoma Staged T1 Treated by Proton Beam Radiotherapy

Zehn Jahre multimodale Therapie uvealer Melanome an der Universitätsaugenklinik Innsbruck

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