Stereotactic Radiosurgery of Uveal Melanomas: Preliminary Results with Gamma Knife Treatment

Abstract

Twelve cases of uveal melanoma (T₃N₀M₀:11 patients, T₄N₀M₀:1 patient) treated with Gamma Knife stereotactic radiosurgery are reported. Our protocol includes preoperative ocular and systemic assessments with complete ocular examination, ophthalmoscopy, fundus photography, fluorangiography, standardized echography, CT and MRI, chest X-rays, liver echography and blood tests. The follow-up program is mainly based on echographic evaluation of tumor thickness and size. The procedures include fixation of the eye, application of the stereotactic Leksell frame G, CT/MRI localization of the melanoma, dose planning and treatment with the Gamma Knife (B type). A mean surface dose of 55 ± 10 Gy was administered at the 60–90% isodose curve using 4- to 14-mm collimators and a number of shots ranging from 1 to 6. A significant reduction (10–41 %) in echographic thickness of the tumor was shown in 6 cases with a follow-up of 3–12 months. In 4 patients, the tumor size was still unchanged after 1–10 months. The single high-dose radiation delivered to the target and the high spatial accuracy are the main advantages of stereotactic radiosurgery for the treatment of posterior uveal melanomas. A longer follow-up is needed to further validate this new application of Gamma Knife radiosurgery.

A mechanical eyeball phantom for uveal melanoma radiosurgery by cyberknife

“…A metal bead that was used to simulate a tumor can be clearly identified in the bottom right image secondary glaucoma. Other options are available along with the development of radiotherapy, including plaque brachytherapy [16,28], proton radiotherapy [23], transpupillary thermotherapy [24], and the promising stereotactic radiotherapy [2,18,21]. Taking the advantages of non-invasive treatment, Cyberknife radiosurgery has become an effective alternative for uveal melanoma.…”

Management of choroidal melanomas with linear accelerator‐based stereotactic radiosurgery

“…The local control rate was reported as being very high (Munzenrider et al 1989). For Leksell Gamma Knife stereotactic radiosurgery, the tumor dose was prescribed at around 55 to 70 Gy (Marchini et al 1995;Rennie et al 1996). Rennie et al reported an 86% local control for a follow-up of nearly 2 years, however, significant radiation induced complications were noted in most of the cases which included retinopathy, rubeotic glaucoma, scleritis and cataract.…”

Die Geschichte der Ophthalmoonkologie an der Univ.-Augenklinik Graz

“…Entscheidende ergänzende Beiträge zur Radiochirurgie von Aderhautmelanomen wurden in engen nationalen/internationalen Kooperationen in Wien [24], Verona [25], und Sheffield [26] geleistet.…”