Systematic Review and Meta-Analysis on the Use of Photon-based Stereotactic Radiosurgery Versus Fractionated Stereotactic Radiotherapy for the Treatment of Uveal Melanoma

Abstract

Purpose: The purpose of this report is to assess the efficacy and adverse event profile of photon-based stereotactic radiosurgery (SRS) compared with fractionated stereotactic radiotherapy (fSRT) for the treatment of uveal melanoma. Primary outcomes include incidence proportions of local control, enucleation, metastatic progression, disease-specific, and overall mortality. Treatment-related toxicities such as incidence proportions of radiation retinopathy, neovascular glaucoma, optic neuropathy, and cataract formation were examined as secondary outcomes. Five-year survival and 5-year local control rates were also assessed. Materials and Methods: PubMed, Embase, Web of Science, Scopus, and 2 Cochrane databases were searched up to December 31, 2018. Random effects models were used to calculate pooled incidence proportions of outcome measures. Meta-regression was carried out to explore the potential impact of dose per fraction on local control. Results: Twenty-four articles with a total of 1745 patients were included in the meta-analysis. There were no statistically significant differences between photon-based fSRT and SRS for all primary, secondary and 5-year outcome measures, including local control (P=0.28), enucleation (P=0.51), and neovascular glaucoma (P=0.40). The 5-year local control rate was 90% (95% confidence interval: 76%, 96%) for fSRT and 89% (70%, 97%) for SRS. Conclusions: Our meta-analysis showed no difference in tumor control, survival and toxicities, as defined in this paper, between SRS and fSRT for uveal melanoma. Confounding biases remain an expected limitation in this study of novel treatment modalities deployed in rare tumors. Further investigation is needed to validate outcomes and compare stereotactic treatment techniques.

Construction and validation of a pyroptosis-related gene signature associated with the tumor microenvironment in uveal melanoma

“…Thirty-three pyroptosis-related genes were extracted from prior studies in Table S2 19 – 23 . The expression levels of 33 pyroptosis-related genes were retrieved from the TCGA and GEO datasets.…”

Radiotherapy in Uveal Melanoma: A Review of Ocular Complications

“…Bensoussan et al studied 492 patients after PBT, reporting an incidence of 27.0% [59]. Kosydar et al conducted a meta-analysis on the use of Photon-based SRT versus fSRT and reported an overall incidence of 16.8% [125]. It is noteworthy that the time frame also varies greatly, with certain patients experiencing early-onset NVG after just a few months, while others develop late-onset NVG several years after treatment.…”

Deterioration of Visual Acuity after Brachytherapy and Proton Therapy of Uveal Melanoma, and Methods of Counteracting This Complication Based on Recent Publications

“…Irradiation of the tumor can be performed in a single session with a high dose of photons (SRS) or in a fractionated form (SRT) [ 11 , 20 , 25 , 26 , 27 , 28 ]. The main advantages of these methods include their minimal invasiveness, excellent local tumor control, relatively wide availability and low costs [ 20 , 25 , 26 , 28 , 29 ]. Some researchers have indicated their disadvantages in the form of lower precision and the associated higher number of post-radiation complications, mainly secondary glaucoma and enucleation compared with brachytherapy and proton therapy [ 11 , 20 , 30 ].…”

“…Some researchers have indicated their disadvantages in the form of lower precision and the associated higher number of post-radiation complications, mainly secondary glaucoma and enucleation Stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS), which also represent external-source radiotherapy, have gained popularity in the treatment of uveal melanoma in recent years. Irradiation of the tumor can be performed in a single session with a high dose of photons (SRS) or in a fractionated form (SRT) [11,20,[25][26][27][28]. The main advantages of these methods include their minimal invasiveness, excellent local tumor control, relatively wide availability and low costs [20,25,26,28,29].…”