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Bechrakis NE, Bornfeld N, Heindl LM, Skoetz N, Leyvraz S, Joussen AM. Uveal Melanoma - Standardised Procedure in Diagnosis, Therapy and Surveillance. Klin Monbl Augenheilkd 2021; 238:761-772. [PMID: 34376006 DOI: 10.1055/a-1534-0198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Uveal melanoma is a rare intraocular tumour, for which there is currently no national evidence-based guideline in Germany. The aim of this project was to provide a common standard operating procedure (SOP) for the diagnosis, treatment and follow-up care of uveal melanoma, within the network of German leading oncology centres funded by German Cancer Aid. The SOP was created as part of a moderated consensus process. RESULTS AND CONCLUSION In a multistage process, a common SOP was developed for the diagnosis, therapy and follow-up of uveal melanoma, as based on current knowledge of the subject.
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Affiliation(s)
| | - Norbert Bornfeld
- Zentrum für Erkrankungen des hinteren Augenabschnitts, Universitätsklinikum Essen, Deutschland
| | - Ludwig M Heindl
- Klinik und Poliklinik für Augenheilkunde, Uniklinik Köln, Deutschland
| | - Nicole Skoetz
- Centrum für integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Medizinische Fakultät und Uniklinik Köln, Deutschland
| | - Serge Leyvraz
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Deutschland
| | - Antonia M Joussen
- Klinik für Augenheilkunde, Charité - Universitätsmedizin Berlin, Deutschland
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Abstract
Local treatment of choroidal melanoma (CM) attracts the attention of many ophthalmology specialists, especially in recent years as the capabilities to target irradiation at small objects and possibilities of surgical interventions on the eyeball have expanded. The article discusses the medical indications for local treatment of CM. Review of literature of the last 16 years and author's own observations on CM patients who underwent almost all kinds of conventional methods of local treatment allowed thorough analysis of indications and counter-indications for their usage. Among the authors who favor local destruction and removal of large CM, the main indication is the possibility to preserve vision and anatomical structures of the eye. This led to unreasonably wide spread of local destruction (removal) of large CM, primarily the endovitreal resection method. However, such metastasis risk factors as CM size and its localization are being overlooked. Literature analysis and author's own observations helped validate the unsafety of the local treatment of large CM. The article features long-term results of contact and distant radiation therapy, and presents CM metrics for best therapeutic effect.
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Affiliation(s)
- A F Brovkina
- Russian Medical Academy of Postgraduate Education, Ministry of Health of the Russian Federation, 2/1 Barrikadnaya St., Moscow, Russian Federation, 123995
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Jasińska-Konior K, Wiecheć O, Sarna M, Panek A, Swakoń J, Michalik M, Urbańska K, Elas M. Increased elasticity of melanoma cells after low-LET proton beam due to actin cytoskeleton rearrangements. Sci Rep 2019; 9:7008. [PMID: 31065009 PMCID: PMC6504917 DOI: 10.1038/s41598-019-43453-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/16/2019] [Indexed: 01/08/2023] Open
Abstract
Cellular response to non-lethal radiation stress include perturbations in DNA repair, angiogenesis, migration, and adhesion, among others. Low-LET proton beam radiation has been shown to induce somewhat different biological response than photon radiation. For example, we have shown that non-lethal doses of proton beam radiation inhibited migration of cells and that this effect persisted long-term. Here, we have examined cellular elasticity and actin cytoskeleton organization in BLM cutaneous melanoma and Mel270 uveal melanoma cells. Proton beam radiation increased cellular elasticity to a greater extent than X-rays and both types of radiation induced changes in actin cytoskeleton organization. Vimentin level increased in BLM cells after both types of radiation. Our data show that cell elasticity increased substantially after low-LET proton beam and persisted long after radiation. This may have significant consequences for the migratory properties of melanoma cells, as well as for the cell susceptibility to therapy.
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Affiliation(s)
- Katarzyna Jasińska-Konior
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Gronostajowa 7, Kraków, Poland
| | - Olga Wiecheć
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Gronostajowa 7, Kraków, Poland
| | - Michał Sarna
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Gronostajowa 7, Kraków, Poland
| | - Agnieszka Panek
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, Kraków, Poland
| | - Jan Swakoń
- Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, Kraków, Poland
| | - Marta Michalik
- Department of Cell Biology, Faculty of Biochemistry, Biophysics and Biotechnology, Gronostajowa 7, Kraków, Poland
| | - Krystyna Urbańska
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Gronostajowa 7, Kraków, Poland
| | - Martyna Elas
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Gronostajowa 7, Kraków, Poland.
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Cho Y, Chang JS, Yoon JS, Lee SC, Kim YB, Kim JH, Keum KC. Ruthenium-106 Brachytherapy with or without Additional Local Therapy Shows Favorable Outcome for Variable-Sized Choroidal Melanomas in Korean Patients. Cancer Res Treat 2017; 50:138-147. [PMID: 28343376 PMCID: PMC5784633 DOI: 10.4143/crt.2016.391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/03/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to report clinical outcomes of ruthenium-106 (106Ru) brachytherapy with or without additional local therapy for choroidal melanomas in Korean patients. Materials and Methods A total of 88 patients diagnosed with choroidal melanomas were treated with 106Ru brachytherapy between 2006 and 2012. Patients were divided into two groups according to their tumor height: a large group (≥ 6 mm, n=50) and a small group (< 6 mm, n=38). Most patients in the large group received combined therapy with local excision and/or transpupillary thermotherapy. In general, 85-95 Gy was administered to the apex of the tumor, while 100 Gy was administered to the point 2-6 mm from the outer surface of the sclera for patients undergoing combined therapy. Results The median follow-up duration was 30 months. The 3-year local control rate was significantly higher in the small group than in the large group (94% vs. 70%, p=0.047). The free from distant metastasis (FFDM) rate and the overall survival (OS) rate were also higher in patients in the small group (3-year FFDM, 97% vs. 76%; p=0.031 and 3-year OS, 97% vs. 72%; p=0.036). A total of 13 patients underwent enucleation. The eye-preservation rate was also higher in the small group (3-year eye-preservation rate, 94% vs. 70%; p=0.050), and tumor height was a significant prognostic factor for eye-preservation. Conclusion 106Ru brachytherapy showed favorable outcomes in small choroidal melanomas in Korean patients. Although additional local treatment could improve eye-preservation rate for large tumors, other strategies should be considered for disease control.
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Affiliation(s)
- Yeona Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sook Yoon
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Ho Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Laser Treatment of Choroidal Melanoma. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00148-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Choroidal melanoma is the most common primary intra-ocular malignant tumor and second most common site of ten malignant melanoma sites in the body. Current diagnosis of choroidal melanoma is based on both the clinical experience of the specialist and modern diagnostic techniques such as indirect ophthalmoscopy, A- and B-ultrasonography scans, fundus fluorescein angiography, and transillumination. Invasive studies such as fine needle aspiration cytology can have significant morbidity and should only be considered if therapeutic intervention is indicated and diagnosis cannot be established by any other means. Several modes of treatment are available for choroidal melanoma. Multiple factors are taken into account when deciding one approach over other approaches, such as visual acuity of the affected eye, visual acuity of the contralateral eye, tumor size, location, ocular structures involved and presence of metastases. A comprehensive review of literature available in books and indexed journals was done. This article discusses in detail epidemiology, diagnosis, current available treatment options, and prognosis and survival of choroidal melanoma.
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Affiliation(s)
- Parul Singh
- Department of Ophthalmology, V. C. S. G. Government Medical Sciences and Research Institute, Srinagar Garhwal, Uttarakhand, India
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A Five-Year Study of Slotted Eye Plaque Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve. Ophthalmology 2012; 119:415-22. [DOI: 10.1016/j.ophtha.2011.08.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 07/28/2011] [Accepted: 08/09/2011] [Indexed: 11/24/2022] Open
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Yarovoy AA, Magaramov DA, Bulgakova ES. The comparison of ruthenium brachytherapy and simultaneous transpupillary thermotherapy of choroidal melanoma with brachytherapy alone. Brachytherapy 2011; 11:224-9. [PMID: 22104351 DOI: 10.1016/j.brachy.2011.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 08/15/2011] [Accepted: 09/08/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare the outcomes of combined treatment of choroidal melanoma with ruthenium brachytherapy (BT) simultaneously with transpupillary thermotherapy (TTT) and treatment with BT alone. METHODS AND MATERIALS Two matched groups of patients, one treated with BT and simultaneous TTT (Group BT+TTT, n=63), the other treated with BT alone (Group BT, n=70) were analyzed retrospectively. The main outcome measures were rate of tumor regression, recurrences, enucleations, metastases, recurrence-free and overall survival rate, and visual acuity, assessed by Kaplan-Meier analysis. RESULTS Patients were matched according to mean age (p=0.22), mean tumor thickness (6.4 vs. 6.25mm, range 2.5-10.8mm, p=0.59), and mean length of followup (42 vs. 34.4 months, range 3-109, p=0.052). Tumor largest basal diameter (13.0 vs. 12.9mm), tumor location, and mean radiation dose (apical 135 vs. 136Gy and scleral 1294 vs. 1438Gy) were also similar in both groups (p>0.1). Treatment with BT+TTT resulted in higher rate of tumor regression (63% vs. 49%, respectively, p=0.036), lower 5-year tumor recurrence rate (96% vs. 83%, p<0.034), and higher eye-globe preservation (98% vs. 87%, p<0.024) and recurrence-free survival rates (89% vs. 67%, p<0.017) than treatment with BT alone. There was no difference in complications (p>0.5), metastasis-free (93% vs. 81%, p>0.22) and overall survival rates (91% vs. 81%, p>0.39), or in visual outcomes. CONCLUSION Combined treatment of choroidal melanoma with ruthenium BT and simultaneous TTT seems to provide higher local control, eye-globe preservation, and recurrence-free survival rates than treatment with BT alone and results in similar rates of metastases and overall survival.
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Affiliation(s)
- Andrey A Yarovoy
- Ocular Oncology Department, The S. Fyodorov Eye Microsurgery Complex, Moscow, Russia.
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Comparing plaque brachytherapy and proton therapy for choroidal melanoma: a review of the literature. JOURNAL OF RADIOTHERAPY IN PRACTICE 2010. [DOI: 10.1017/s1460396909990197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe aims of conservative treatment in patients with ocular melanoma are globe retention, good visual acuity (VA) and local control. Two well-established radiation conservative treatment options are proton beam radiotherapy and episcleral plaque brachytherapy (EPB). Patients who receive treatment with either of these options will experience some degree of radiation-related ocular complications and poor VA. The purpose of this review of the literature is to establish whether there is a significant clinical difference in normal tissue morbidity and local tumour control between proton therapy and EPB, and whether this difference can justify the purchase and implementation of additional proton therapy facilities. Based on this review, evidence suggested that both treatment options are comparable, and that neither proton therapy nor EPB is clinically superior than the other regarding normal tissue morbidity and local tumour control. This review highlighted the need for further research on a larger scale in order to bridge the gap that is apparent within the literature.
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Isager P, Ehlers N, Urbak SF, Overgaard J. Visual outcome, local tumour control, and eye preservation after 106Ru/Rh brachytherapy for choroidal melanoma. Acta Oncol 2009; 45:285-93. [PMID: 16644571 DOI: 10.1080/02841860500468950] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To study the visual outcome, local tumour control, and eye preservation 5 years after ruthenium/rhodium 106 brachytherapy for choroidal melanoma. The study included 55 consecutive patients treated by 106Ru/Rh brachytherapy for a choroidal melanoma during the period 1988-2000 and followed through 2004. The 5-year probability for not losing at least 5 Snellen lines was 59% (n = 45), for retaining a visual acuity of 0.33 or better was 28% (n = 34), and for retaining better than 0.1 was 40% (n = 45). The 5-year probability for no local recurrence was 73% and for eye preservation 72% (n = 55). 106Ru/Rh brachytherapy for choroidal melanoma resulted in a clinically significant vision loss, no local recurrence, and eye preservation in most patients after 5 years. 106Ru/Rh brachytherapy can be regarded as a good treatment option for small and medium-sized tumours but not for large tumours.
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Affiliation(s)
- Peter Isager
- Department of Ophthalmology, Arhus University Hospital, Denmark.
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RETINAL BREAK AND RHEGMATOGENOUS RETINAL DETACHMENT AFTER TRANSPUPILLARY THERMOTHERAPY AS PRIMARY OR ADJUNCT TREATMENT OF CHOROIDAL MELANOMA. Retina 2008; 28:274-81. [DOI: 10.1097/iae.0b013e318145abe8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dias RS, Giordani AJ, Erwenne CM, Segreto HRC, Teixeira LF, Segreto RA. Braquiterapia com rutênio-106 em melanomas uveais - resultados preliminares: experiência uni-institucional. Radiol Bras 2007. [DOI: 10.1590/s0100-39842007000200008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar os resultados preliminares da braquiterapia com rutênio-106 em pacientes portadores de melanomas uveais. MATERIAIS E MÉTODOS: No período de abril de 2002 a julho de 2003, 20 pacientes com diagnóstico de melanoma uveal foram tratados com braquiterapia com rutênio-106. A dose calculada no ápice tumoral variou de 55 Gy a 100 Gy. Pacientes com lesões com altura maior que 5 mm foram submetidos a termoterapia transpupilar concomitante à colocação da placa oftálmica. RESULTADOS: Quanto à localização da lesão, esta se encontrava na coróide em 75% dos casos, na íris em 15% e no corpo ciliar em 10% dos pacientes. Com seguimento mediano de 19 meses, a sobrevida livre de progressão para a braquiterapia e para a associação com a termoterapia transpupilar foi de 69% e 87%, respectivamente. Observou-se redução significante da altura tumoral após o tratamento. Nenhum dos pacientes foi submetido a enucleação. CONCLUSÃO: Nossos resultados preliminares mostram que a braquiterapia com rutênio-106 é uma opção adequada para o tratamento conservador de melanomas uveais em termos de controle local, manutenção do globo ocular e visão útil, com índice aceitável de complicações.
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Kreusel KM, Bechrakis N, Riese J, Krause L, Wachtlin J, Foerster MH. Combined brachytherapy and transpupillary thermotherapy for large choroidal melanoma: tumor regression and early complications. Graefes Arch Clin Exp Ophthalmol 2006; 244:1575-80. [PMID: 16738857 DOI: 10.1007/s00417-006-0357-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 04/16/2006] [Accepted: 04/18/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND To determine the effectiveness and risk profile of combined ruthenium- (Ru)-106-brachytherapy and transpupillary thermotherapy (TTT) of the tumour apex for the treatment of large choroidal melanoma. METHODS A consecutive series of 31 large choroidal melanoma treated by Ru-106-brachytherapy and adjuvant TTT was studied. TTT was performed 1 day prior to plaque removal and up to 3 times (mean: 1.8) during follow-up. Evaluation comprised tumour regression, treatment-related adverse events, necessity of additional treatment and visual results. RESULTS Mean follow-up was 21.6+/-7.8 (10.8-38.3) months. Mean tumour thickness was 6.8+/-1.0 (5.0-8.9) mm prior to treatment. Mean residual tumour thickness at the end of follow-up was 2.5+/-1.0 mm. Relevant adverse treatment effects were exudative maculopathy or macula oedema (22.6%), vitreous haemorrhage (16.1%), optic neuropathy (16.1%) and retinal detachment (9.7%). One tumour recurrence occurred during follow-up, and was treated by enucleation. CONCLUSIONS The combination of Ru-106-brachytherapy with TTT allows for the treatment of large posterior choroidal melanoma. The rate of treatment-related adverse events appears to be acceptable.
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Spire M, Devouassoux MSB, Kodjikian L, Janin-Magnificat H, Fleury J, Grange JD. Primary transpupillary thermotherapy for 18 small posterior pole uveal melanomas. Am J Ophthalmol 2006; 141:840-849. [PMID: 16678505 DOI: 10.1016/j.ajo.2005.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 11/13/2005] [Accepted: 12/12/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate transpupillary thermotherapy (TTT) for the treatment of small uveal melanomas of the posterior pole. DESIGN Prospective, nonrandomized interventional case series. METHODS Eighteen patients underwent TTT for small uveal melanomas located in the posterior pole of the eyes. Tumors were between 2.5 and 4 mm in thickness. TTT was performed with a diode laser at 810 nm. Patients had between one and three TTT sessions, with an intensity adapted to the coloration of the fundus impact. Biomicroscopic examination, ultrasonographic measurements, and angiography were performed before and two months, four months, and six months after treatment, then regularly during follow-up. RESULTS Eight of the 18 tumors regressed and 10 recurred. The one- and two-year metastasis-free survival rates calculated by the Kaplan-Meier method were, respectively, 61.11% to 44.44% (95% confidence interval). Recurrences were managed with enucleation (three patients), proton beam therapy (six), or additional thermotherapy (one). After treatment, visual acuity was maintained or improved for the eight patients with nonrecurrent tumors. Pathologic analysis of the three enucleated eyes revealed scleral invasion. CONCLUSIONS Despite encouraging initial short-term results obtained with TTT for the management of small choroidal melanomas, the occurrence of severe complications, especially recurrences and insufficient local tumor control, should raise concern about indications for primary TTT given as isolated treatment for small melanomas of the posterior pole.
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Affiliation(s)
- Myriam Spire
- Department of Ophthalmology, Croix-Rousse Hospital, EA 3090, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
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Mills MD, Harbour JW. Lipid exudation following plaque radiotherapy for posterior uveal melanoma. Am J Ophthalmol 2006; 141:594-595. [PMID: 16490526 DOI: 10.1016/j.ajo.2005.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 10/06/2005] [Accepted: 10/07/2005] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate factors associated with lipid exudation after plaque radiotherapy for uveal melanoma. DESIGN Retrospective interventional case series. METHODS Records of 139 consecutive uveal melanoma patients treated with I-125 plaque radiotherapy were reviewed. Lipid exudation was the major outcome measured. RESULTS Lipid exudation was detected in 19 patients (13.7%). Mean time from plaque therapy to lipid exudation was 10 months (range, 3-23 months). Lipid exudation was associated with younger patient age (P = .0002), increased low-density lipoprotein (P = .004), decreased high-density lipoprotein (P = .026), increased tumor thickness (P = .024), and exudative retinal detachment (P = .016). Patients with lipid exudation had worse visual outcome (P < .0001) and increased neovascular glaucoma (P = .01). CONCLUSIONS Lipid exudation after plaque radiotherapy for uveal melanoma is associated with poor ocular outcome. Factors associated with this lipid exudation are distinct from those associated with radiation retinopathy, and they may suggest interventions to combat this complication.
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Affiliation(s)
- Michael D Mills
- Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
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Affiliation(s)
- Rosa Y Kim
- Vitreoretinal Consultants, Houston, TX 77090, USA
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Bornfeld N, Anastassiou G. Laser Treatment of Choroidal Melanoma. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Langmann G, Lechner H, Wenzel E, Mossböck G, Wackernagel W. Transpupillare Thermotherapie (TTT) von Aderhautmelanomen. Ophthalmologe 2005; 102:1162-7. [PMID: 15947964 DOI: 10.1007/s00347-005-1232-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increasing number of orbital recurrences after TTT have been reported; the aim of our paper was to present our long-term results after a maximum follow-up of 8 years and 2 months. PATIENTS AND METHOD Among 18 eyes, 10 tumors were classified as small, and 8 as medium sized (with a maximum prominence of 5.6 mm): 5 melanomas had a juxtapapillary location, 6 a macular (or juxtamacular) location, and 7 were located in the midperiphery of the fundus. RESULTS After a median follow-up of 7 years in seven tumors a complete regression (scar formation) could be achieved, and in six a partial regression (with a maximum residual prominence of 2.9 mm) could be seen. In three patients a recurrence was treated either by another TTT or a Ruthenium-106 plaque; in another two recurrences, enucleation had to be performed. In none of the cases has an orbital recurrence occurred so far. CONCLUSION To prevent recurrences, adequate technique and appropriate selection of patients are mandatory in our opinion (no tumors higher than 3 mm). The higher the tumor prominence, the greater the chance of recurrences. Amelanotic melanomas and macular melanomas seem to respond poorly to thermotherapy.
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Affiliation(s)
- G Langmann
- Augenklinik, Medizinische Universität Graz.
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Singh AD, Rundle PA, Berry-Brincat A, Parsons MA, Rennie IG. Extrascleral extension of choroidal malignant melanoma following transpupillary thermotherapy. Eye (Lond) 2004; 18:91-3. [PMID: 14707980 DOI: 10.1038/sj.eye.6700512] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Harbour JW, Meredith TA, Thompson PA, Gordon ME. Transpupillary thermotherapy versus plaque radiotherapy for suspected choroidal melanomas. Ophthalmology 2003; 110:2207-14; discussion 2215. [PMID: 14597531 DOI: 10.1016/s0161-6420(03)00858-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To examine the outcomes and complications of transpupillary thermotherapy for treatment of small choroidal melanomas. DESIGN Retrospective case-matched comparative study and retrospective observational study. PARTICIPANTS The case-matched study consisted of 36 patients treated with either transpupillary thermotherapy or plaque radiotherapy (18 patients per group). The observational study consisted of 21 patients treated with transpupillary thermotherapy alone (primary transpupillary thermotherapy) and 9 patients treated with transpupillary thermotherapy plus plaque radiotherapy (adjuvant transpupillary thermotherapy). MAIN OUTCOME MEASURES Visual acuity, local tumor control, and metastasis. RESULTS The case-matched groups did not differ significantly with respect to age, gender, initial visual acuity, tumor location, or length of follow-up (mean, 33 months for transpupillary thermotherapy vs. 40 months for plaque radiotherapy). There was no significant difference in final visual acuity (P = 0.810) or postoperative visual acuity change (P = 0.919) between the 2 groups. In the observational study, the mean follow-up was 32 months (range, 4-58 months). Indications for primary transpupillary thermotherapy included documented growth (10 patients) and the presence of >/=3 risk factors for growth (11 patients). Retinal complications occurred in 16 patients (76%). The mean posttreatment visual acuity change was minus 2 lines (range, minus 9 to plus 7 lines). Local failure occurred in 6 patients (29%). Local failure was associated with an increased number of transpupillary thermotherapy spots per session (P = 0.023) and decreased tumor pigmentation (P = 0.001). Indications for adjuvant transpupillary thermotherapy included tumor radioresistance (6 patients) and the presence of risk factors for local failure (3 patients). All 9 tumors that received adjuvant transpupillary thermotherapy regressed rapidly, with no local failures. The mean postoperative visual acuity change was -1.9 lines (range, -9 to +5 lines). No patient in either study developed metastasis. CONCLUSIONS The recent interest in transpupillary thermotherapy as primary therapy for choroidal melanoma is based largely on the assumption that transpupillary thermotherapy may provide better visual outcomes than plaque radiotherapy. However, this study found no significant difference in visual outcomes between transpupillary thermotherapy and plaque radiotherapy. Further, the local failure rate with transpupillary thermotherapy was substantially higher than with plaque radiotherapy. The most promising role for transpupillary thermotherapy seems to be as an adjunct to plaque radiotherapy. The appropriate indications for transpupillary thermotherapy in the management of choroidal melanoma need to be re-evaluated.
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Affiliation(s)
- J William Harbour
- Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.
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Robertson DM. TTT as rescue treatment for choroidal melanoma not controlled with iodine-125 brachytherapy. Ocul Immunol Inflamm 2002; 10:247-52. [PMID: 12854033 DOI: 10.1076/ocii.10.4.247.15587] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe the use of transpupillary thermotherapy in the management of two small choroidal melanomas that continued to grow following Iodine-125 brachytherapy. METHODS Case reports from a tertiary care center. RESULTS One small growing choroidal melanoma showed a partial response to Iodine-125 brachytherapy; four years later, it regrew to a thickness of 2.7 mm. After transpupillary thermotherapy (TTT), the tumor regressed to a flat scar and has remained inactive for more than three years. A second small melanoma failed to show regression after Iodine-125 brachytherapy; it progressively grew to 3.6 mm. TTT was used to treat the tumor on two successive occasions six weeks apart. The tumor regressed to a flat scar within three months and has remained inactive for 2.5 years. CONCLUSION TTT may be considered as a rescue treatment for small choroidal melanomas that have failed to respond satisfactorily to brachytherapy.
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Affiliation(s)
- Dennis M Robertson
- Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA. robertson/
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Kiratli H, Bilgiç S. Subretinal pigment dispersion following transpupillary thermotherapy for choroidal melanoma. ACTA OPHTHALMOLOGICA SCANDINAVICA 2002; 80:401-4. [PMID: 12190783 DOI: 10.1034/j.1600-0420.2002.800410.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To report the case of a patient who developed considerable subretinal pigment/debris dispersion following transpupillary thermotherapy (TTT). This type of tumour response is extremely rare with this relatively new therapeutic modality. METHODS A 50-year-old man with a left juxtapapillary choroidal melanoma measuring 8 x 6 x 4.3 mm was treated with 810 nm diode laser TTT administered in two sessions. Spot size was 3 mm and the power setting was 450 mW. RESULTS Four months after the first treatment session, a considerable amount of pigment/debris was seen to have dispersed in the subretinal space, accumulating mainly in the macular area. Over a 12-month follow-up, the tumour showed progressive shrinkage without any change in the amount or location of the shed pigment/debris. No new tumour formation, recurrence or systemic metastases were detected. CONCLUSION Subretinal pigment/debris dispersion is an unusual complication after TTT and requires close follow-up. There has been no short-term compromise on the life or visual acuity of this patient.
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Affiliation(s)
- Hayyam Kiratli
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.
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Abstract
During the past 20 years of enucleation, which was the standard treatment for choroidal melanoma over more than a century, has largely been replaced by eye salvaging therapies such as radiotherapy or local resection. In 1995 transpupillary thermotherapy (TTT) using an infrared diode laser was introduced as a new conservative therapy for patients with choroidal melanoma. TTT can be defined as a heat treatment modality, which is delivered through a dilated pupil to the tumour surface. The technique uses a wide diode laser beam diameter with a low irradiance and a long exposure time. TTT induces tumour necrosis at sub-photocoagulation levels by a direct cell destructive effect with only a few ocular complications. TTT can be performed as sole therapy or combined with plaque radiotherapy, thus permitting a lower radiation dose. For amelanotic tumours dye-enhanced TTT with indocyanine green can be used. In this paper we review the role of sole or combined TTT, related to the current other treatment modalities for choroidal melanoma.
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Affiliation(s)
- J G Journée-de Korver
- Department of Ophthalmology, Ocular Oncology Service, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
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