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Flanagan JPM, Fog LS, Astrahan MA, Talbot LJ, McKay D, Phillips C, McKenzie JD, O'Day R. Apical dose versus volume dose of Ruthenium-106 brachytherapy for uveal melanoma. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00074-7. [PMID: 38582499 DOI: 10.1016/j.jcjo.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Ruthenium-106 brachytherapy is commonly used to treat uveal melanomas. Most centres prescribe a radiation dose to the tumour apex that is calculated with the tumour located in the centre of the plaque. Recent work suggests that D99%-the minimum radiation dose delivered to 99% of tumour volume-may be a better predictor of tumour control than apex dose. Both dosing regimens may be affected by tumour and treatment variables differently. We explored the effect of differences in these variables on volume and apex dose using a 3-dimensional planning model. METHODS The time required to deliver 100 Gy to the tumour apices of representative tumours ranging from 2- to 6-mm thickness with central plaque positioning was calculated in Plaque Simulator™. This treatment time was used for further calculations, including D99% with central plaque placement, and apical and tumour volume doses when tumour and plaque characteristics were altered, including eccentric plaque placement, either away from (tilt) or along (offset) scleral surface, tumour shape, and plaque type. RESULTS D99% was always greater than the apex dose when plaques were placed centrally, and the difference increased with tumour thickness. Increasing degrees of tumour offset reduced apical dose and D99%, with a greater effect on apical dose for thicker and D99% for thinner tumours, respectively. Differences in tumour shape and plaque type had idiosyncratic effects on apical and volume dosing. CONCLUSION D99% and apex dose are affected by tumour and treatment characteristics in different ways, highlighting the complexity of radiation delivery to uveal tumours.
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Affiliation(s)
- Jeremy P M Flanagan
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne (Victoria), Australia; Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia
| | - Lotte S Fog
- Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Melvin A Astrahan
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Lachie J Talbot
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne (Victoria), Australia
| | - Daniel McKay
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Claire Phillips
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne (Victoria), Australia
| | - John D McKenzie
- Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia
| | - Roderick O'Day
- Ocular Oncology Research Unit, Centre for Eye Research Australia, Melbourne (Victoria), Australia; Department of Ocular Oncology, Royal Victorian Eye and Ear Hospital, Melbourne (Victoria), Australia. roderick.o'
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De Brabandere M, Placidi E, Siebert FA, Carlsson Tedgren Å, Slocker Escarpa A, Tagliaferri L, Andrássy M, Schulz C, Fog LS. GEC-ESTRO survey of 106Ru eye applicator practice for ocular melanoma - Physicist survey. Radiother Oncol 2024; 193:110114. [PMID: 38309583 DOI: 10.1016/j.radonc.2024.110114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/05/2024]
Abstract
AIM 106Ru eye plaque brachytherapy (BT, interventional radiotherapy) is an eye-preserving treatment for uveal melanoma performed in about 100 clinics worldwide. Despite this relatively low number, there is a considerable variation in clinical practice. In 2022, the BRAPHYQS and Head & Neck and Skin GEC-ESTRO working groups conducted a survey to map the current clinical practice. The survey consisted of a physicist and a physician part. This paper describes the physicist results. However, three physician questions with overlapping interest are included here as well. MATERIALS AND METHODS The survey questions pertained to commissioning and quality control (QC) of the plaques, treatment planning, radiobiological correction, as well as more general questions on practice improvement. The questions overlapping with the physician survey were related to dose prescription and margins. RESULTS Sixty-five physicist responses were included. A majority of the centres do not perform an independent measurement of the absorbed dose at reference depth, percentage depth dose (PDD) and off-axis data. A lack of calibration services and suitable equipment are the main reasons. About one third of the centres indicated that they do image based treatment planning. The use of margins and dose prescription showed a large variability, despite the availability of guidelines [1]. Many respondents expressed a strong wish for improvement in a wide range of aspects of clinical practice. CONCLUSION The physics survey showed a wide variability regarding quality control of the 106Ru sources and treatment planning practice.
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Affiliation(s)
| | - Elisa Placidi
- UOC Physics for Life Sciences, Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Frank-André Siebert
- Clinic of Radiotherapy (Radiooncology), University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Luca Tagliaferri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Rome, Italy
| | - Michael Andrássy
- Eckert & Ziegler BEBIG GmbH, Robert-Rössle-Straße 10, 13125 Berlin, Germany
| | - Carmen Schulz
- Eckert & Ziegler BEBIG GmbH, Robert-Rössle-Straße 10, 13125 Berlin, Germany
| | - Lotte S Fog
- Ocular oncology unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Alfred Health Radiation Oncology, Melbourne, VIC, Australia
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3
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Kal Omar R, Hagström A, Dahlander S, Carlsson Tedgren Å, Stålhammar G. A Prognostic Score for the Prediction of Local Treatment Failure in Plaque Brachytherapy of Uveal Melanoma. Adv Radiat Oncol 2023; 8:101152. [PMID: 36896210 PMCID: PMC9991540 DOI: 10.1016/j.adro.2022.101152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/12/2022] [Indexed: 12/26/2022] Open
Abstract
Purpose To develop a prognostic score that correlates to a low, medium, and high incidence of treatment failure after plaque brachytherapy of uveal melanoma (UM). Methods and Materials All patients who have received plaque brachytherapy for posterior UM at St. Erik Eye Hospital in Stockholm, Sweden from 1995 through 2019 were included (n = 1636). Treatment failure was defined as tumor recurrence, lack of tumor regression, or any other condition requiring a secondary transpupillary thermotherapy (TTT), plaque brachytherapy, or enucleation. The total sample was randomized into 1 training and 1 validation cohort, and a prognostic score for the risk for treatment failure was developed. Results In multivariate Cox regression, low visual acuity, tumor distance to the optic disc ≤2 mm, American Joint Committee on Cancer (AJCC) stage, and a tumor apical thickness of >4 (for Ruthenium-106) or >9 mm (for Iodine-125) were independent predictors of treatment failure. No reliable threshold could be identified for tumor diameter or cancer stage. In competing risk analyses of the validation cohort, the cumulative incidence of treatment failure, as well as of secondary enucleation, increased with the prognostic score: In the low, intermediate, and high-risk classes, the 10-year incidence of treatment failure was 19, 28, and 35% and of secondary enucleation 7, 19, and 25 %, respectively. Conclusions Low visual acuity, American Joint Committee on Cancer stage, tumor thickness, and tumor distance to the optic disc are independent predictors of treatment failure after plaque brachytherapy for UM. A prognostic score was devised that identifies low, medium, and high risk for treatment failure.
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Affiliation(s)
- Ruba Kal Omar
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Hagström
- Department of Clinical Neuroscience, Division of Eye and Vision, Unit of Ocular Oncology and Pathology, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Simon Dahlander
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Carlsson Tedgren
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Radiation Physics, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gustav Stålhammar
- Department of Clinical Neuroscience, Division of Eye and Vision, Unit of Ocular Oncology and Pathology, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.,St. Erik Eye Hospital, Stockholm, Sweden
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Fionda B, Pagliara MM, Chyrek AJ, Guix B, O'Day RFJ, Fog LS, Martínez-Monge R, Tagliaferri L. Ocular Brachytherapy (Interventional Radiotherapy): Preserving the Vision. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00043-2. [PMID: 36792447 DOI: 10.1016/j.clon.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Abstract
Uveal melanoma represents the most common intraocular neoplasia among adults. Brachytherapy (interventional radiotherapy; IRT) has a great advantage, when compared with enucleation, both in terms of organ and function sparing. The Collaborative Ocular Melanoma Study introduced into clinical practice a standardised procedure that allowed the equivalence of IRT with enucleation in terms of overall survival to be demonstrated. IRT is carried out by placing a plaque in direct contact with the sclera under the uveal melanoma. Several radioactive sources may be used, including 106-ruthenium, 125-iodine, 103-palladium and 90-strontium. It is a multidisciplinary procedure requiring the collaboration of interventional radiation oncologists and ophthalmologists in the operating theatre and medical physicists for an accurate treatment time calculation. It also relies on ultrasound imaging to identify the lesion and verifiy the correct plaque placement. An emerging tool of paramount importance could be the use of artificial intelligence and predictive models to identify those patients at higher risk of developing late side-effects and therefore who may deserve preventive and supportive therapies.
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Affiliation(s)
- B Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - M M Pagliara
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, Neurologiche Ortopediche e Della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A J Chyrek
- Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland
| | - B Guix
- Department of Radiation Oncology, Foundation IMOR, Barcelona, Spain
| | - R F J O'Day
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - L S Fog
- The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - R Martínez-Monge
- Department of Oncology, Clínica Universitaria de Navarra, CCUN, Pamplona, Spain
| | - L Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Gerard A, Peyrichon M, Vidal M, Barnel C, Sauerwein W, Carnicer A, Angellier G, Mathis T, Mishra K, Thariat J, Herault J. Ocular proton therapy, pencil beam scanning high energy proton therapy or stereotactic radiotherapy for uveal melanoma; an in silico study. Cancer Radiother 2022; 26:1027-1033. [PMID: 35803862 DOI: 10.1016/j.canrad.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE In radiotherapy, the dose and volumes of the irradiated normal tissues is correlated to the complication rate. We assessed the performances of low-energy proton therapy (ocular PT) with eye-dedicated equipment, high energy PT with pencil-beam scanning (PBS) or CyberKnifeR -based stereotactic irradiation (SBRT). MATERIAL AND METHODS CT-based comparative dose distribution between external beam radiotherapy techniques was assessed using an anthropomorphic head phantom. The prescribed dose was 60Gy_RBE in 4 fractions to a typical posterior pole uveal melanoma. Clinically relevant structures were delineated, and doses were calculated using radiotherapy treatment planning softwares and measured using Gafchromic dosimetry films inserted at the ocular level. RESULTS Precision was significantly better with ocular PT than both PBS or SBRT in terms of beam penumbra (80%-20%: laterally 1.4 vs. ≥10mm, distally 0.8 vs. ≥2.5mm). Ocular PT duration was shorter, allowing eye gating and lid sparing more easily. Tumor was excellent with all modalities, but ocular PT resulted in more homogenous and conformal dose compared to PBS or SBRT. The maximal dose to ocular/orbital structures at risk was smaller and often null with ocular PT compared to other modalities. Mean dose to ocular/orbital structures was also lower with ocular PT. Structures like the lids and lacrimal punctum could be preserved with ocular PT using gaze orientation and lid retractors, which is easier to implement clinically than with the other modalities. The dose to distant organs was null with ocular PT and PBS, in contrast to SBRT. CONCLUSIONS ocular PT showed significantly improved beam penumbra, shorter treatment delivery time, better dose homogeneity, and reduced maximal/mean doses to critical ocular structures compared with other current external beam radiation modalities. Similar comparisons may be warranted for other tumor presentations.
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Cicinelli MV, Di Nicola M, Gigliotti CR, Battista M, Miserocchi E, Vecchio A, Mortini P, Bandello F, Modorati GM. Predictive factors of radio-induced complications in 194 eyes undergoing gamma knife radiosurgery for uveal melanoma. Acta Ophthalmol 2021; 99:e1458-e1466. [PMID: 33638277 DOI: 10.1111/aos.14814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/03/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE To report the factors predictive of radio-induced complications (i.e. radiation retinopathy [RR], radiation papillopathy [RP] and neovascular glaucoma [NVG]) in uveal melanoma (UM) patients undergoing gamma knife radiosurgery (GKR). MATERIALS AND METHODS Longitudinal cohort study on patients with UM treated at the Ocular Oncology Service, San Raffaele Scientific Institute, Milan, between June 1994 and November 2018. Data were retrospectively reviewed. Rates of GKR-related complications were reported. Variables associated with each complication were investigated using multivariable Cox models and confirmed by logistic regression analysis. Hazard ratio (HR) and 95% confidence intervals (CI) were reported for significant associations. RESULTS One hundred ninety-four patients (99 males, 51%) were included, and 184 tumours were primarily located in the choroid (95%). Median follow-up was 57 months (range 6-286). Local control was achieved in 182 eyes (94%), and 152 eyes (78%) experienced at least one radiation-induced complication. Radiation retinopathy was documented in 67 eyes (35%) after a median of 23 months. Older age (HR = 0.97, 95% CI = 0.95-0.99, p = 0.02) had a protective effect for RR. Radiation papillopathy was diagnosed in 35 eyes (18%) after a median of 14 months after GKR. Macular or peripapillary location (HR = 3.06, 95% CI = 1.52-6.16, p = 0.002) was associated with increased risk of RP, while older age was protective (HR = 0.95, 95% CI = 0.93-0.98, p = 0.001). New-onset NVG was found in 53 eyes (27%), and median onset was 28 months. Tumour thickness (HR = 4.41, 95% CI = 2.23-8.72, p < 0.001) and peripapillary location (HR = 2.78, 95% CI = 1.46-5.27, p = 0.002) were the main risk factors associated with NVG. CONCLUSION Understanding factors predictive for radiation-related complications in patients undergoing GKR might help for better counselling and treatment planning.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
| | - Maura Di Nicola
- Ocular Oncology Service University of Cincinnati College of Medicine Cincinnati OH USA
| | | | - Marco Battista
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Antonella Vecchio
- Department of Medical Physics IRCCS San Raffaele Scientific Institute Milan Italy
| | - Pietro Mortini
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Neurosurgery and Gamma Knife Radiosurgery IRCCS San Raffaele Scientific Institute Milan Italy
| | - Francesco Bandello
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
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Buonanno F, Conson M, de Almeida Ribeiro C, Oliviero C, Itta F, Liuzzi R, Pacelli R, Cella L, Clemente S. Local tumor control and treatment related toxicity after plaque brachytherapy for uveal melanoma: A systematic review and a data pooled analysis. Radiother Oncol 2021; 166:15-25. [PMID: 34774654 DOI: 10.1016/j.radonc.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 01/02/2023]
Abstract
Uveal melanoma (UM) represents the most common primary intraocular tumor, and nowadays eye plaque brachytherapy (EPB) is the most frequently used visual acuity preservation treatment option for small to medium sized UMs. The excellent local tumor control (LTC) rate achieved by EPB may be associated with severe complications and adverse events. Several dosimetric and clinical risk factors for the development of EPB-related ocular morbidity can be identified. However, morbidity predictive models specifically developed for EPB are still scarce. PRISMA methodology was used for the present systematic review of articles indexed in PubMed in the last sixteen years on EPB treatment of UM which aims at determining the major factors affecting local tumor control and ocular morbidities. To our knowledge, for the first time in EPB field, local tumor control probability (TCP) and normal tissue complication probability (NTCP) modelling on pooled clinical outcomes were performed. The analyzed literature (103 studies including 21,263 UM patients) pointed out that Ru-106 EPB provided high local control outcomes while minimizing radiation induced complications. The use of treatment planning systems (TPS) was the most influencing factor for EPB outcomes such as metastasis occurrence, enucleation, and disease specific survival, irrespective of radioactive implant type. TCP and NTCP parameters were successfully extracted for 5-year LTC, cataract and optic neuropathy. In future studies, more consistent recordings of ocular morbidities along with accurate estimation of doses through routine use of TPS are needed to expand and improve the robustness of toxicity risk prediction in EPB.
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Affiliation(s)
- Francesca Buonanno
- University Federico II, Post Graduate School in Medical Physics, Department of Advanced Biomedical Sciences, Napoli, Italy
| | - Manuel Conson
- University Federico II, Department of Advanced Biomedical Sciences, Napoli, Italy
| | | | - Caterina Oliviero
- University Hospital Federico II, Unit of Medical Physics and Radioprotection, Napoli, Italy
| | - Francesca Itta
- University Federico II, Post Graduate School in Medical Physics, Department of Advanced Biomedical Sciences, Napoli, Italy
| | - Raffaele Liuzzi
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy
| | - Roberto Pacelli
- University Federico II, Department of Advanced Biomedical Sciences, Napoli, Italy
| | - Laura Cella
- National Research Council (CNR), Institute of Biostructures and Bioimaging, Napoli, Italy.
| | - Stefania Clemente
- University Hospital Federico II, Unit of Medical Physics and Radioprotection, Napoli, Italy
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Espensen CA, Kiilgaard JF, Klemp K, Gothelf A, Appelt AL, Fog LS. 3D image-guided treatment planning for Ruthenium-106 brachytherapy of choroidal melanomas. Acta Ophthalmol 2021; 99:e654-e660. [PMID: 33340258 DOI: 10.1111/aos.14663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 10/11/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current standard treatment procedures for Ruthenium-106 (Ru-106) brachytherapy for choroidal melanomas do not use 3D image-guided treatment planning. We evaluated the potential impact of introducing 3D treatment planning and quantified the theoretical clinical benefits in terms of tumour control probability (TCP) and normal tissue complication probability (NTCP). MATERIALS AND METHODS Treatment plans for thirty-two patients were optimized using 3D image-guided treatment planning and compared to the original 2D clinical plans. Optimization of plans was done in an image-based treatment planning system by optimizing the plaque position and treatment time such that the entire tumour received the prescribed dose of 100 Gy. TCP and NTCP for 2D clinical plans and optimized 3D image-guided plans were estimated from published outcome prediction models and compared within patients using Wilcoxon signed-rank test. RESULTS The median minimum tumour dose (D99% ) for 2D clinical plans was 93 Gy (range: 23-158 Gy), corresponding to 5-year TCP of 75% (IQR 61-86%), while median tumour D99% for optimized 3D image-guided plans was 115 Gy (range 103-141 Gy), corresponding to TCP of 82% (IQR 80-84%). This was a statistically significant increase in estimated TCP (median increase in TCP 8% (IQR: -5-23, p = 0.006). While the dose to normal tissue increased somewhat, there was no significant change in NTCP. CONCLUSION 3D treatment planning theoretically allows for improved tumour dose delivery for Ru-106 brachytherapy of choroidal melanomas, resulting in a significant increase in expected tumour control compared to traditional approaches using 2D calculations. The deliverability of optimized plans, and potential increased risk of late complications, will have to be confirmed in future clinical studies.
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Affiliation(s)
- Charlotte A. Espensen
- Department of Oncology Section of Radiotherapy Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jens F. Kiilgaard
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Kristian Klemp
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anita Gothelf
- Department of Oncology Section of Radiotherapy Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ane L. Appelt
- Leeds Institute of Medical Research at St James’s, University of Leeds Leeds Cancer Centre University of LeedsSt James’s University Hospital Leeds UK
- Leeds Cancer Centre St James’s University Hospital Leeds UK
| | - Lotte S. Fog
- The Alfred Hospital Alfred Health Radiation Oncology Melbourne Victoria Australia
- The Peter MacCallum Cancer Centre Melbourne Victoria Australia
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Reichstein DA, Brock AL. Radiation therapy for uveal melanoma: a review of treatment methods available in 2021. Curr Opin Ophthalmol 2021; 32:183-190. [PMID: 33770014 DOI: 10.1097/icu.0000000000000761] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Radiation therapy has become the standard of care for the treatment of uveal melanoma. We intend to outline the current radiation therapy methods that are employed to treat uveal melanoma. We will outline their relative benefits over one another. We will also provide some background about radiation therapy in general to accustom the ophthalmologists likely reading this review. RECENT FINDINGS Four main options exist for radiation therapy of uveal melanoma. Because the eye is a small space, and because melanomas are relatively radioresistant, oncologists treating uveal melanoma must deliver highly focused doses in high amounts to a small space. Therapies incorporating external beams include proton beam therapy and stereotactic radiosurgery. Stereotactic radiosurgery comes in two forms, gamma knife therapy and cyberknife therapy. Radiation may also be placed directly on the eye surgically via plaque brachytherapy. All methods have been used effectively to treat uveal melanoma. SUMMARY Each particular radiotherapy technique employed to treat uveal melanoma has its own set of benefits and drawbacks. The ocular oncologist can choose amongst these therapies based upon his or her clinical judgment of the relative risks and benefits. Availability of the therapy and cost to the patient remain significant factors in the ocular oncologist's choice.
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10
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Correspondence. Retina 2021; 41:e35-e36. [PMID: 33464023 DOI: 10.1097/iae.0000000000003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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