Results of ruthenium irradiation of uveal melanoma

Tjho-Heslinga, R.E.; Kakebeeke-Kemme, H. M.; Davelaar, J.; Vroome, H. de; Bleeker, J.C.; Oosterhuis, J. A.; Leers, JM

doi:10.1016/0167-8140(93)90170-d

Cited by 24 publications

(8 citation statements)

References 8 publications

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“…10 Under general anaesthesia the tumour was located by funduscopy and diaphanoscopy and its borders were marked with surgical ink. A transparent dummy was placed on the marked sclera for pre-placement of scleral fixation sutures (Mersilene 4-0).…”

Section: Patients Materials and Methodsmentioning

confidence: 99%

Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience

Bartlema

Oosterhuis²,

Korver³

et al. 2003

British Journal of Ophthalmology

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Aim: To evaluate the results of combined plaque radiotherapy and transpupillary thermotherapy (TTT) in 50 consecutive patients 5 years after treatment. Methods: 50 adult patients with choroidal melanoma were treated with ruthenium-106 ( 106 Ru) plaque radiotherapy combined with TTT. A flat scar was the preferred end point of treatment. The mean tumour thickness was 3.9 mm (range 1.5-8.0 mm), the mean tumour diameter was 11.3 mm (range 5.8-15.0 mm). TTT was performed with an infrared diode laser at 810 nm, a beam diameter of 2-3 mm, and 1 minute exposures. Tumours .5 mm thick received an episcleral contact dose of 800 Gy 106 Ru; tumours (5 mm thick received a contact dose of 600 Gy 106 Ru. TTT was repeated in case of incomplete tumour regression after combined therapy. Results: Complete tumour regression was obtained in 45 patients. It required one, two, or three TTT sessions in 32, 11, and two patients, respectively. In tumours (3 mm thick complete flattening was achieved significantly faster than in tumours .3 mm thick (log rank test p = 0.01). Eight melanomas were amelanotic, seven of which required multiple TTT sessions. In one patient the tumour recurred at the central margin of the treated area; this eye was enucleated. In one patient the tumour failed to regress 6 months after treatment and enucleation was performed at the patient's request. Three eyes developed severe proliferative retinopathy. Radiation maculopathy caused a loss of the best corrected visual acuity: before treatment 31 patients had a best corrected visual acuity of 20/60 or better but in only 12 patients did it remain in this range 5 years after treatment. Three patients developed distant metastasis to the liver. Conclusion: The 5 year results for combined plaque radiotherapy and TTT as treatment for choroidal melanoma are favourable in terms of complete tumour regression and low rate of recurrences; however, there was considerable loss of visual acuity as a result of radiation maculopathy.

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Section: Patients Materials and Methodsmentioning

confidence: 99%

Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience

Bartlema

Oosterhuis²,

Korver³

et al. 2003

British Journal of Ophthalmology

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“…Some claim that 75"/0 of patients that have ruthenium plaque radiotherapy for posterior uveal melanoma retain useful vision (Guthoff et al 1986;Tjho-Heslinga et al 1993), or that pre-treatment visual acuity is preserved in 72% of patients (Muller et al 1986). However, to compare the visual outcome in different groups of patients receiving plaque radiotherapy is exceedingly difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Ruthenium plaque radiotherapy for posterior uveal melanoma was conceptualized in the 1960s and subsequently popularized by Lommatzsch (Lommatzsch & Vollmar 1966;Lommatzsch 1986). Since then, brachytherapy using ruthenium 106 has been adopted by a large number of ocular oncology centres (Guthoff et al 1986;Miiller et al 1986;Shields et al 1989;Grange et al 1990;Bacin et al 1991;Summanen et al 1993;Tjho-Heslinga et al 1993;Kleineidam et al 1993). In Sweden, ruthenium plaque radiotherapy was introduced in 1979 and the facilities have remained confined to one centre.…”

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confidence: 99%

Results following episcleral ruthenium plaque radiotherapy for posterior uveal melanoma The Swedish experience

Seregard

Trampe

Lax

et al. 1997

Acta Ophthalmologica Scandinavica

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ABSTRACT. The Swedish experience of ruthenium 106 plaque radiotherapy for posterior uveal melanoma includes 266 patients treated between 1979 and 1995. The median dose delivered at the tumour apex was 100 Gy and the median follow-up after radiotherapy was 3.6 years (range = 0.5 to 12.5 years) with no patient being lost to follow-up. Visual acuity deteriorated moderately following treatment but appeared to stabilize after 5 to 6 years. Treatment failure defined as enucleation following plaque treatment occurred in 46 of the 266 (17%) studied patients. The cumulative 5-year probability of retaining the eye after radiotherapy was 82% and by univariate analysis tumour height, tumour diameter and tumour stage each predicted subsequent treatment failure, whereas in multivariate analysis no single covariate retained a predictive value. Forty-five of the 266 patients died of any cause during follow-up; 27 of these deaths were melanoma-related. The cumulative 5-year survival proportion (based on melanoma-related deaths only) was 86%. Death in metastatic disease appeared to be more common among patients that failed ruthenium plaque radiotherapy, however these patients also tended to have large tumours.

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“…Publication of unverifiable data still continues e.g. visual acuities between 6/24 and zero are unspecified, and statements such as 'stable disease', defined as 'an elevated remnant, remaining unchanged for at least one year' are equally vague [23].…”

Section: Failure To Appreciate the Consequences Of 'Doubling Time'mentioning

confidence: 99%

Uveal melanoma: updated considerations on current management modalities

1995

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Published data on growth rates of uveal melanomas and effects of treatment modalities raise important considerations. Dissemination from uveal melanomas starts after the tumour is larger than 7 mm diameter; growth from 7 to 10 mm diameter increases the risk of metastases incrementally to approximately 16%. Estimations of turnout doubling times indicate that metastatic death before 8 years is nearly always due to pre-therapeutic dissemination so that the impact on survival by therapy can only be assessed thereafter. Histopathology on irradiated melanomas reveals that reproductive activity has not been suppressed and the anticipated (and unfavourable) risk of metastases is not balanced by poor post-irradiation visual acuity. Also the psychological well-being of a patient with a functional fellow eye is better after primary enucleation. Conservative management is most appropriate for: small melanomas, patients with a short life expectancy, melanomas in a single functioning eye, and patients refusing enucleation.Optimum treatment of any form of neoplastic disease by modern therapeutic modalities should ideally be based on an accurate knowledge of the biological behaviour of the specific neoplastic process. With regard to ocular melanomas, there are serious gaps in knowledge concerning growth rates in situ and in the documentation of the time intervals between the presentation of the primary tumour and the appearance of metastases. The rarity of the tumour necessitates careful accumulation of data, so that an adequate analysis can be made of the claimed success of cure rates. Equally important, the side effects and the complications of treatment should be the subject of careful scrutiny. In this communication the literature on the relevant aspects of melanoma biology and current treatment modalities is critically analysed. Tumour biology Tumour doubling timeInformation on tumour doubling time of uveal melanomas was introduced in 1980 [1] and updated reviews were provided in 1987 [2] and in 1992 [3]. From this data it was possible to estimate the risk of metastatic disease in relation to the dimensions of the tumour. The application of meta analysis provided by Diener-West and associates [4] and Markowitz et al. [5] has indicated that a radical reappraisal of the current philosophy of management is required. When do uveal melanomas metastasize ?In 1984, an editorial in the American Journal of Ophthalmology stated that 'it is unclear at what stage in its course a uveal melanoma develops the capacity to metastasize ' [6]. However an analysis of the data then available in the literature provided evidence which indicated that metastatic disease does not occur until

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Results of ruthenium irradiation of uveal melanoma

Cited by 24 publications

References 8 publications

Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience

Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience

Results following episcleral ruthenium plaque radiotherapy for posterior uveal melanoma The Swedish experience

Uveal melanoma: updated considerations on current management modalities

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