Stereotactic Radiosurgery and Fractionated Stereotactic Radiation Therapy for the Treatment of Uveal Melanoma

Yazıcı, Gözde; Kıratlı, Hayyam; Özyiğit, Gökhan; Sarı, Sezin Yüce; Cengiz, Mustafa; Tarlan, Berçin; Özgen, Burçe; Zorlu, Faruk

doi:10.1016/j.ijrobp.2017.02.017

Cited by 30 publications

(31 citation statements)

References 35 publications

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“…Nowadays, the therapy standard consists of plaque brachytherapy and charged particle therapy with protons [ 10 , 11 ]. Additionally, other treatment modalities like stereotactic radiosurgery with gammaknife or cyberknife as well as stereotactic fractionated photon radiotherapy gain in importance [ 6 , 12 – 14 ]. Prospective studies comparing external beam RT and BRT are still missing.…”

Section: Discussionmentioning

confidence: 99%

Linear accelerator-based stereotactic fractionated photon radiotherapy as an eye-conserving treatment for uveal melanoma

et al. 2018

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BackgroundThe purpose of this retrospective analysis is to analyze clinical outcome, visual acuity and enucleation rates after linear accelerator-based stereotactic fractionated photon radiotherapy for primary uveal melanoma.MethodsTwenty-four patients with primary uveal melanoma treated at the Department of Radiation and Oncology of the University Hospital Heidelberg between 1991 and 2015 were analyzed regarding survival and treatment-related toxicity including eye- and sight-preservation.ResultsPhoton radiotherapy (RT) offered good overall local control rates with a local progression-free survival (LPFS) of 82% after 5 years and a median LPFS of 5.5 years at a median follow-up time of 5.2 years. Gender had a significant impact on LPFS yielding a mean LPFS of 8.1 years for women and 8.7 years for men (p = 0.04). Of all local progressions, 80% occurred within the first 5 years after RT. In one case, enucleation as final therapy option was necessary. Enucleation-free survival (EFS) was related to the radiotherapy dose (p < 0.0001). Thus, higher prescribed doses led to a significantly higher enucleation rate. T-stage had no significant impact on EFS, but affected the enucleation rate (p = 0.01). The overall survival (OS) rate was 100% after 2 years and 70% after 5 years with a median OS of 5.75 years. Age (p = 0.046), T stage (p = 0.019), local control rate (p = 0.041) and the time between diagnosis and the first radiation session (p = 0.01) had a significant effect on OS. Applied biologically effective dose (BED) did not significantly influence OS or PFS. A 2-year sight preservation rate of 75% could be achieved. In all patients, irradiation could be applied safely without any interruptions due to side effects. Six significant late toxicities with consequential blindness could be observed, making a secondary enucleation necessary in four patients. An impairment of visual acuity due to chronic optic nerve atrophy was identified in five patients within 2 years after treatment.ConclusionsLinear accelerator-based stereotactic fractionated photon radiotherapy is an effective method in the treatment of uveal melanoma with excellent local control rates and a 2-year vision retention rate comparable to brachytherapy (BRT) or proton beam radiotherapy, even available in small centers and easy to implement. Interdisciplinary decision making is necessary to guarantee best treatment for every patient.

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Section: Discussionmentioning

confidence: 99%

Linear accelerator-based stereotactic fractionated photon radiotherapy as an eye-conserving treatment for uveal melanoma

et al. 2018

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“…A novel technique of radiotherapy of uveal melanoma is stereotactic radiotherapy based on the concept that ionizing radiation from different directions is focused on the tumor delivering a high dose of these ionizing radiation to the tumor with little effect on the surrounding tissues. [ 34 ]…”

Section: Endoresectionmentioning

confidence: 99%

Choroidal melanoma resection

Hamza

Elhusseiny

2018

Middle East Afr J Ophthalmol

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Uveal melanoma is the most common intraocular malignant tumor, with the choroid being the most common site. Management of choroidal melanoma has evolved greatly over the past years. In the past, the conventional method of treatment was enucleation of the affected eye with a debate regarding the effect of enucleation to promote or prevent metastasis. However, nowadays, there are many therapeutic options available including plaque radiotherapy, proton beam radiotherapy, argon laser photocoagulation, transpupillary thermotherapy, stereotactic radiotherapy using gamma knife, enucleation, and surgical resection of the tumor whether through transscleral approach “Exoresection” or less commonly through internal resection approach “Endoresection.” The indications and complications of each technique are reviewed. Although radiotherapy is the primary treatment of choroidal melanoma in most ocular oncology centers, it is used as an adjuvant therapy in combination with surgical resection. Preoperative stereotactic radiotherapy before endoresection and brachytherapy to the surgical bed in both exo and endoresection can effectively decrease the recurrence rate. In this article, we will focus on surgical resection of choroidal melanoma whether endoresection or exoresection. We collected data published in indexed journals and related books.

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“…Все выше перечисленное определяет социальную значимость данного заболевания. [2], стереотаксическое облучение [4], протонотерапия [5][6][7], которые в большей степени применяют при лечении опухолей средних размеров (высота опухоли до 6,0 мм). При лечении МХ больших размеров (высота опухоли более 6,0 мм) основным методом лечения, особенно по данным отечественных источников [8; 9], продолжает оставаться энуклеация глаза, которая является калечащей операцией и не предотвращает развитие метастазов [7].…”

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Treatment of Large Choroidal Melanoma by the Brachytherapy With Ruthenium-106 and Vitreoretinal Surgery

Yarovoy¹,

Gorshkov²,

Демидов³

et al. 2019

СПНО (MPSE)

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Цель исследования-оценить эффективность лечения больших меланом хориоидеи (МХ) методом брахитерапии (БТ) с рутением-106 и эндовитреальной хирургии. В исследование включено 59 пациентов (59 глаз) с МХ высотой опухоли более 6 мм и максимальным диаметром основания (МДО) опухоли не более 16,5 мм. Средняя высота МХ до БТ составила 7,5±1,2 мм, средний МДО составил 12,0±2,3 мм. Из 59 больных 31 (53%) пациенту после БТ проведено эндовитреальное вмешательство (ЭВ) с эндорезекцией (ЭР) остаточной опухоли (группа БТ+ЭР), а остальным 28 (47%) пациентам после БТ проведено ЭВ без удаления остаточной опухоли (группа БТ+ЭВ). Средний срок наблюдения пациентов составил-55,9±33,0 мес. Продолженный рост опухоли после БТ наблюдали в 9 (15%) случаях. Вторичная энуклеация глаза выполнена у 2 (3%) пациентов. Развитие метастазов МХ имело место в двух случаях-3%. Отрицательные результаты предложенного метода лечения больших МХ имели место в 5 случаях: в одном-развилась субатрофия глаза вследствие тотальной тракционной отслойки сетчатки, в двухвыполнена энуклеация по поводу субатрофии глаза без признаков активной МХ, в двух-отмечены отдаленные метастазы. Ключевые слова: увеальная меланома, меланома хориоидеи, брахитерапия, эндовитреальное вмешательство, эндорезекция, глаз сохраняющее лечение.

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Stereotactic Radiosurgery and Fractionated Stereotactic Radiation Therapy for the Treatment of Uveal Melanoma

Cited by 30 publications

References 35 publications

Linear accelerator-based stereotactic fractionated photon radiotherapy as an eye-conserving treatment for uveal melanoma

Linear accelerator-based stereotactic fractionated photon radiotherapy as an eye-conserving treatment for uveal melanoma

Choroidal melanoma resection

Treatment of Large Choroidal Melanoma by the Brachytherapy With Ruthenium-106 and Vitreoretinal Surgery

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