Robotic radiosurgery for the treatment of medium and large uveal melanoma

Abstract

The aim of the study was to analyze the local efficacy and eye retention rate after frameless, image-guided robotic radiosurgery against uveal melanoma. A total of 217 patients, mostly with medium and large unilateral uveal melanomas (3% small, 62% medium, and 35% large) were treated. The median age was 64 years (range 21-95 years). All patients underwent a single-session procedure beginning with retrobulbar anesthesia, followed by MRI and computerized tomography scanning to generate the treatment plan. The tumor dose was 18-22 Gy (mean, 20.3 Gy) prescribed to the 70% isodose line. Follow-up occurred at 3, 6, 12, and 18 months and yearly thereafter with clinical, ultrasound, and MRI studies. The median follow-up time was 26.4 months. All patients were treated in the frameless setup within 3 h. The actuarial 3- and 5-year eye retention rates were 86.7 and 73%, respectively. Local control at 3 and 5 years was 87.4 and 70.8%, respectively. Serviceable vision was maintained in 30.9% of patients at last follow-up. Treatment-induced glaucoma developed in 33 patients at a median 20.8 months (range, 5.8-54.0 months). Other adverse effects were hemorrhage (26 patients) and macular edema (seven patients). Frameless, single-session, image-guided robotic radiosurgery is an effective and straightforward treatment option for patients with medium and large uveal melanoma that are otherwise difficult to treat.

Early Results of Stereotactic Radiosurgery in Uveal Melanoma and Risk Factors for Radiation Retinopathy

“…However, their case series was small, and the follow-up period was short. In a later paper from the same group, Eibl-Lindner et al 19 reported the results of 18-22 Gy SRS on 217 patients with medium or large uveal melanoma and reported a globe preservation rate of 86.7% at 3 years and 73% at 5 years.…”

Secondary glaucoma in small versus large uveal melanoma patients treated with stereotactic radiosurgery on linear accelerator

“…They realized a comparable safety profi le in terms of incidence of SG to both radiation modalities. Irradiation techniques have a great importance for eye retention, but SG with tumor recurrence make up 82-90 % of reasons for secondary enucleation (37, 41,42).…”

Technique for Robotic Stereotactic Irradiation of Choroidal Melanoma

“…Treatments have been typically delivered using a single fraction on a Gamma Knife unit with retrobulbar anesthesia [ 9 ]. Reports using the CyberKnife platform are less common with the largest experience being from Munich where patients are treated with a regimen analogous to that used on the Gamma Knife (single fraction using retrobulbar anesthesia) [ 10 ]. In the German series of more than 200 patients, the estimated five-year local failure rate was approximately 30%, and 30% of patients retained serviceable eyesight (defined as 6/20 or better).…”