The Risk of Enucieatlon after Proton Beam Irradiation of Uveal Melanoma

Egan, Kathleen M.; Gragoudas, Evangelos S.; Seddon, Johanna M.; Glynn, Robert J.; Munzenreider, John; Goitein, Michael; Verhey, Lynn; Urie, Marsha; Koehler, Andreas

doi:10.1016/s0161-6420(89)32738-2

Cited by 104 publications

(45 citation statements)

References 13 publications

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“…10 Adverse effects of proton beam therapy include radiation retinopathy and papillopathy, 11 loss of vision, 10,12 cataract, 13,14 and, infrequently, enucleation. 15 Factors positively associated with an increased risk of vision loss and radiation vasculopathy, in particular, include tumor height and proximity to the optic disc or fovea.…”

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confidence: 99%

A Randomized Controlled Trial of Varying Radiation Doses in the Treatment of Choroidal Melanoma

Gragoudas¹

2000

Arch Ophthalmol

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146

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To determine if a reduction in proton radiation dose from the standard dose of 70 cobalt gray equivalents (CGE) to 50 CGE would decrease radiation-induced complications, thereby improving visual prognosis, without compromising local tumor control for patients with uveal melanoma at high risk of these complications.Design: Randomized, double-masked clinical trial.Participants: A total of 188 patients with small or medium-sized choroidal melanomas (Ͻ15 mm in diameter and Ͻ5 mm in height) near the optic disc or macula (within 4 disc diameters of either structure).Methods: Patients were treated with proton beam therapy at doses of either 50 CGE or 70 CGE between October 1989 and July 1994, and followed up biannually through April 1998. Outcomes included visual acuity, radiation complications, melanoma recurrence, and metastasis.Results: Proportions of patients retaining visual acuity of at least 20/200 were similar in the 2 dose groups at 5 years after radiation (approximately 55%). Similar numbers of patients in each group experienced tumor regrowth (2 patients at 50 CGE vs 3 patients at 70 CGE; PϾ.99) and metastasis (7 patients at 50 CGE vs 8 patients at 70 CGE; P=.79). Five-year rates of radiation maculopathy also were similar (for both groups, approximately 75% for tumors within 1 disc diameter and 40% for tumors Ͼ1 disc diameter from the macula). Rates of radiation papillopathy were nonsignificantly decreased in the 50-CGE treatment group when tumors were located 1 disc diameter or less from the optic disc (P=.20). Patients treated with the lower dose also experienced significantly less visual field loss.Conclusions: This level of dose reduction did not result in a lesser degree of visual acuity loss. The lowerdose group did experience significantly less visual field loss. Local tumor recurrence and metastatic death rates were similar in both dose groups.

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confidence: 99%

A Randomized Controlled Trial of Varying Radiation Doses in the Treatment of Choroidal Melanoma

Gragoudas¹

2000

Arch Ophthalmol

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146

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“…Helium ion beams had been used in Lawrence Berkeley Laboratory for choroidal melanomas, the actuarial 5-and 10-year local control was 96% (Linstadt et al 1990). Proton beam with fractionated schedule was used for choroidal melanomas with Harvard Cyclotron, 96.3% of local control was reported (Egan et al 1989). The results are compatible with enucleation.…”

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confidence: 71%

“…Both radioactive plaque therapy and charge particle therapy appear to be equivalent to enucleation in terms of overall survival, and have the obvious advantages of retention of the eye and preservation of useful vision in some cases (Char 1989;Egan et al 1989;Linstadt et al 1988). The principle of these approaches is to deliver a precision high dose to cover the tumor area without affecting the normal eye tissues.…”

Section: Discussionmentioning

confidence: 99%

Management of choroidal melanomas with linear accelerator‐based stereotactic radiosurgery

Leung

Hsiung

Chen

et al. 1999

Acta Ophthalmologica Scandinavica

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ABSTRACT.Purpose: To discuss the technical aspect, dose prescription, clinical results, and biological responsiveness of linear accelerator-based stereotactic radiosurgery for choroidal melanoma. Methods: From March 1995 to December 1995, three choroidal melanoma patients were treated with Linac-based radiosurgery in our department. Two patients underwent one dose of radiosurgery with 18 and 20 Gy in single fraction, respectively. The third patient received two doses of radiosurgery with a total dose of 35 Gy. Results: Follow-up time ranged from 19 to 25 months (median: 24 months). One patient had near-total regression, while the other two patients had partial response on the last MR images. Visual acuity was deteriorated in all patients. One patient developed a radiation-induced cataract in the treated eye. Conclusion: Linac-based radiosurgery is technically feasible for management of choroidal melanoma. Although visual acuity was not improved in these patients, they appreciated the preserving of the eyeball without affecting their general appearance.

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“…Persistent retinal detachment is untreatable, and the risk of neovascular glaucoma increases from approximately 3 to 35% [100]. Large tumor size is also associated with an increased risk of local tumor recurrence and enucleation [10,79]. On one hand posterior tumor location close to the optic disc or fovea (< 2 disc diameters) increases the risk of radiation-induced optic neuropathy and/or maculopathy as well after as plaque treatment after external beam radiotherapy (53 in 3).…”

Section: Choroidal Tumorsmentioning

confidence: 99%

Current Conservative Management Strategies for Uveal Melanoma

Müller¹

1998

Oncol Res Treat

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Primary malignant intraocular tumors are rare. Of these, malignant melanomas represent about 75%; 20% are retinoblastomas and 5% are primary intraocular lymphomas. In the management of patients with malignant melanoma of the ciliary body and choroid (posterior uvea), treatment techniques have included not only surgery (enucleation and orbital exenteration in very advanced cases) but also photocoagulation, local resection, and cryotherapy. Since the introduction of radioactive plaque therapy about 35 years ago, this type of bulb-conserving procedure has become very popular and today is the most favored treatment in certain stages of malignant uveal melanoma. Other radiooncological methods like proton beam or helium ions have also proven to be effective in these ocular malignancies but can only be performed in selected places in few countries. Thermoradiation is still experimental and has to prove its routine clinical use and effectiveness. Because of promising results, local resection in combination with adjunctive radioactive plaque therapy probably seems to be used more often in the future. The primary goal of treatment is not only conservation of the eye with acceptable vision, but also to gain the same prognosis as with enucleation. Despite many reliable treatment results, authorities still disagree whether enucleation or conservative treatment offers the best prognosis, although many retrospective studies have suggested that the method of treatment makes no difference in the systemic prognosis.

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The Risk of Enucieatlon after Proton Beam Irradiation of Uveal Melanoma

Cited by 104 publications

References 13 publications

A Randomized Controlled Trial of Varying Radiation Doses in the Treatment of Choroidal Melanoma

A Randomized Controlled Trial of Varying Radiation Doses in the Treatment of Choroidal Melanoma

Management of choroidal melanomas with linear accelerator‐based stereotactic radiosurgery

Current Conservative Management Strategies for Uveal Melanoma

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