Proton radiation therapy for medium and large choroidal melanoma: preservation of the eye and its functionality

Fuß, Martin; Loredo, Lilia N.; Blacharski, Paul A.; Grove, Roger; Slater, Jerry D.

doi:10.1016/s0360-3016(00)01430-9

Cited by 107 publications

(96 citation statements)

References 15 publications

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“…Alternative treatments include brachytherapy [14,25,26], gamma-knife radiosurgery [27], proton beam radiation [28,29], fractionated stereotactic radiotherapy [30,31], and partial lamellar sclerouvectomy [32]. However, none of these alternative therapies has been evaluated prospectively.…”

Section: Discussionmentioning

confidence: 99%

“…Enucleation has traditionally been the treatment of choice for the majority of large UMs [5], however, in certain situations such as the presence of a tumor in the only remaining eye, poor vision in the fellow eye, or whenever a patient insists on avoiding enucleation, conservative treatment modalities aimed at preserving the diseased eye can be considered [3]. Although improving patient survival has been claimed as the most important rationale to support enucleation as the standard of care for large UM, the Collaborative Ocular Melanoma Study (COMS) results (report No 28) as well as publications by independent groups show that different treatment options, either conservative or radical (enucleation), are not associated with a definitive survival benefit [6,7,8,9]. This is one of the reasons that enucleation has been largely replaced by conservative modalities such as brachytherapy, proton beam radiation, stereotactic radiotherapy, and tumor resection in recent years [4,5].…”

Section: Purposementioning

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: Purposementioning

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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“…Hence, this technique is used for this disease as a method with expected outcomes equivalent to those of surgical enucleation and brachytherapy with 106 Ruapplicators wherever available. Eye preservation rates range between 75% and 92% [9][10][11][12][13][14][15][16][17][18]20] when doses of around 60 GyE are used in four fractions. Gragoudas et al [13] tested 50 vs 60 GyE in a prospective Phase III trial and could not find a significant difference in LC.…”

Section: Uveal Melanomamentioning

confidence: 99%

Review of clinical experience with ion beam radiotherapy

Jensen

Münter²,

Debus³

2011

BJR

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ABSTRACT. The article describes both the early development of oncology as a core discipline at the University of Heidelberg Hospital and the first steps towards ion beam treatment, from the pilot project carried out in co-operation with the Gesellschaft fü r Schwerionenforschung Darmstadt to the initial start-up of clinical service at the Heidelberg Heavy Ion Centre (HIT). We present an overview, based on data published in the literature, of the available clinical evidence relating the use of ion beam therapy to treat major indications in active particle centres. A rationale for the use of particle therapy in each of these indications is given. In view of the limited availability of data, we discuss the necessity to conduct clinical trials. We also look forward towards the next activities to be undertaken at the HIT.

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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%