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Semeniuk O, Yu E, Rivard MJ. Current and Emerging Radiotherapy Options for Uveal Melanoma. Cancers (Basel) 2024; 16:1074. [PMID: 38473430 DOI: 10.3390/cancers16051074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
What treatment options are there for patients having uveal melanoma? A randomized, prospective, multi-institutional clinical trial (COMS) showed no difference in survival between brachytherapy and enucleation for medium-sized lesions. With the obvious benefit of retaining the eye, brachytherapy has flourished and many different approaches have been developed such as low-dose-rate sources using alternate low-energy photon-emitting radionuclides, different plaque designs and seed-loading techniques, high-dose-rate brachytherapy sources and applicators, and low- and high-dose-rate beta-emitting sources and applicators. There also have been developments of other radiation modalities like external-beam radiotherapy using linear accelerators with high-energy photons, particle accelerators for protons, and gamma stereotactic radiosurgery. This article examines the dosimetric properties, targeting capabilities, and outcomes of these approaches. The several modalities examined herein have differing attributes and it may be that no single approach would be considered optimal for all patients and all lesion characteristics.
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Affiliation(s)
- Oleksii Semeniuk
- Department of Radiation Oncology, Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI 02903, USA
| | - Esther Yu
- Department of Radiation Oncology, Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI 02903, USA
| | - Mark J Rivard
- Department of Radiation Oncology, Warren Alpert Medical School, Brown University and Rhode Island Hospital, Providence, RI 02903, USA
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Detorakis ET, Perisinakis K, Drakonaki E, Liakopoulos D, Tzedakis A, Papadaki E, Tsilimbaris MK. MRI and dual-energy CT fusion anatomic imaging in Ru-106 ophthalmic brachytherapy. Brachytherapy 2021; 20:828-834. [PMID: 33785279 DOI: 10.1016/j.brachy.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/25/2020] [Accepted: 01/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Brachytherapy with Ru-106 is widely used for the treatment of intraocular tumors, and its efficacy depends on the accuracy of radioactive plaque placement. Ru-106 plaques are MRI incompatible and create severe metal artifacts on conventional CT scans. Dual-energy CT scans (DECT) may be used to suppress such artifacts. This study examines the possibility of creating fusion images from MRI scans (preoperatively) and DECT scans (with the plaque in place) as a tool for confirming the anatomic accuracy of plaque placement. METHODS AND MATERIALS Six patients with intraocular lesions (5 with choroidal melanoma and 1 with a retinal vasoproliferative lesion) were included. Fusion images of preoperative MRI scans and DECT scans with the plaque in place were created with the Demo version of the ImFusion suite (ImFusion GmbH, Munchen Germany). Clearance margins between the tumor and plaque edge in axial, transverse, and coronal planes as well as the elevation of the posterior plaque edge from the sclera were recorded and associated with the location of the lesion. RESULTS Plaque-tumor clearance margins for transverse, sagittal, and coronal planes were higher for anteriorly located lesions (5.13 mm ± 0.11 [5.0-5.2], 5.10 mm ± 0.26 [4.9-5.4], and 5.33 mm ± 0.45 [4.9-5.8] respectively) than for posteriorly located lesions (4.16 mm ± 1.44 [2.5-5.1], 4.13 mm ± 1.42 [2.5-5.1], and 4.2 mm ± 1.21 [2.8-5.0], respectively). The elevation of the posterior plaque edge from the sclera was 0.33 mm ± 0.28 [0-0.5] and 0.63 mm ± 0.60 [0.7-1.2] for posterior and anterior lesions, respectively. CONCLUSIONS Fusion images between DECT and MRI scans may be used as a tool to confirm the accuracy of Ru-106 plaque placement in relation with the intraocular tumors in ophthalmic brachytherapy.
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Affiliation(s)
| | - Kostas Perisinakis
- Department of Medical Physics, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Eleni Drakonaki
- Department of Anatomy, Medical School, European University of Cyprus, Nicosia, Cyprus
| | | | - Antonios Tzedakis
- Department of Medical Physics, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Efrosini Papadaki
- Department of Medical imaging, University Hospital of Heraklion, Crete, Greece
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Krohn J, Chen YC, Stabo-Eeg NO, Hamre B. Cherenkov Luminescence Imaging for Assessment of Radioactive Plaque Position in Brachytherapy of Uveal Melanoma: An In Vivo Feasibility Study. Transl Vis Sci Technol 2020; 9:42. [PMID: 32832247 PMCID: PMC7414660 DOI: 10.1167/tvst.9.7.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/08/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To study the feasibility of using Cherenkov luminescence imaging (CLI) to evaluate and document ruthenium-106 plaque position during brachytherapy of uveal melanoma. Methods Ruthenium-106 decays by emitting high-energy beta particles. When the electrons pass through the eye, Cherenkov radiation generates a faint light that can be captured by highly sensitive cameras. Patients undergoing ruthenium-106 plaque brachytherapy for posteriorly located choroidal melanoma were examined by CLI, which was performed in complete darkness with an electron multiplying charged-coupled device camera mounted on a fundus camera modified for long exposures. Results Ten patients with tumors ranging from 5.8 to 13.0 mm in largest basal diameter and 2.0 to 4.6 mm in height were included. The plaques had an activity between 0.035 and 0.089 MBq/mm2 at the time of examination (1–4 days after implantation). CLI revealed the actual plaque position by displaying a circular area of light in the fundus corresponding with the plaque area. The Cherenkov light surrounded the tumor as a halo, which showed some asymmetry when the plaque was slightly displaced. The light intensity correlated positively with plaque activity and negatively with tumor pigmentation. Exposure times between 30 and 60 seconds were required to display the plaque position and delineate the tumor area. The long exposures made it difficult to maintain stable eye fixation and optimal image quality. Conclusions CLI is a novel method to assess and document ruthenium-106 plaque position in brachytherapy for uveal melanoma. Translational Relevance Ocular CLI may provide relevant radiation data during and after implantation of radioactive plaques, thus improving the accuracy of episcleral brachytherapy.
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Affiliation(s)
- Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.,Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Yi-Chun Chen
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Nils Ole Stabo-Eeg
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Børge Hamre
- Department of Physics and Technology, University of Bergen, Bergen, Norway
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Navaratnam J, Bærland TP, Eide NA, Faber RT, Rekstad BL, Vavvas DG, Bragadóttir R. Fundus Autofluorescence Change as an Early Indicator of Treatment Effect of Brachytherapy for Choroidal Melanomas. Ocul Oncol Pathol 2019; 5:445-453. [PMID: 31768369 DOI: 10.1159/000499403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/05/2019] [Indexed: 12/29/2022] Open
Abstract
Background Early confirmation of the effect of brachytherapy for choroidal melanoma showing that tumour coverage is valuable. The irradiated retinal pigment epithelium (RPE) commonly develops atrophy. This study compares the fundus autofluorescence (AF) changes to the development of RPE atrophy following brachytherapy. Methods Retrospective study of 19 patients treated with <sup>106</sup>Ru and 2 with <sup>125</sup>I plaques with either a 3- or 6-month follow-up period. Ultra-widefield (UW) composite colour and AF images were obtained with Optomap 200Tx and interpreted as complete, partial, or no RPE changes and complete or partial hyperautofluorescence, hypoautofluorescence, or isoautofluorescence. Results At the 3-month follow-up, 9 of 13 patients (69%) (95% confidence interval [CI], 0.389-0.896) treated with <sup>106</sup>Ru plaques developed complete homogenous hyperautofluorescence surrounding the tumour, but only 1 of 13 (8%) (95% CI, 0.004-0.379) developed complete RPE atrophy at the same time point. Six patients in the <sup>106</sup>Ru plaque group had their first follow-up with UW imaging at 6 months. Four of them developed homogenous hyperautofluorescence and none developed complete RPE atrophy around the tumour. The 2 patients treated with <sup>125</sup>I did not demonstrate any clear RPE or AF changes. Conclusion The effect of <sup>106</sup>Ru plaque treatment on fundus UW imaging is detected as homogenous and well-demarcated hyperautofluorescence before visible RPE atrophy.
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Affiliation(s)
- Jesintha Navaratnam
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Thomas P Bærland
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Nils A Eide
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Rowan T Faber
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Bernt L Rekstad
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ragnheiður Bragadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
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Vafay Eslahi S, Ji J. Accelerated positive contrast MRI of interventional devices using parallel compressed sensing imaging. Magn Reson Imaging 2019; 60:130-136. [PMID: 31028791 DOI: 10.1016/j.mri.2019.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 11/24/2022]
Abstract
Susceptibility-based magnetic resonance imaging (MRI) method can image small MR-compatible devices with positive contrast. However, the relatively long data acquisition time required by the method hinders its practical applications. This study presents a parallel compressive sensing technique with a modified fast spin echo to accelerate data acquisition for the susceptibility-based positive contrast MRI. The method integrates the generalized autocalibrating partially parallel acquisitions and the compressive sensing techniques in the reconstruction algorithm. MR imaging data acquired from several phantoms containing interventional devices such as biopsy needles, stent, and brachytherapy seeds, used for validating the proposed technique. The results show that it can speed up data acquisition by a factor of about five while preserving the quality of the positive contrast images.
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Affiliation(s)
- Samira Vafay Eslahi
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
| | - Jim Ji
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA.
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Zoberi JE, Garcia-Ramirez J, Hedrick S, Rodriguez V, Bertelsman CG, Mackey S, Hu Y, Gach HM, Rao PK, Grigsby PW. MRI-based treatment planning and dose delivery verification for intraocular melanoma brachytherapy. Brachytherapy 2017; 17:31-39. [PMID: 28818442 DOI: 10.1016/j.brachy.2017.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/30/2017] [Accepted: 07/14/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Episcleral plaque brachytherapy (EPB) planning is conventionally based on approximations of the implant geometry with no volumetric imaging following plaque implantation. We have developed an MRI-based technique for EPB treatment planning and dose delivery verification based on the actual patient-specific geometry. METHODS AND MATERIALS MR images of 6 patients, prescribed 85 Gy over 96 hours from Collaborative Ocular Melanoma Study-based EPB, were acquired before and after implantation. Preimplant and postimplant scans were used to generate "preplans" and "postplans", respectively. In the preplans, a digital plaque model was positioned relative to the tumor, sclera, and nerve. In the postplans, the same plaque model was positioned based on the imaged plaque. Plaque position, point doses, percentage of tumor volume receiving 85 Gy (V100), and dose to 100% of tumor volume (Dmin) were compared between preplans and postplans. All isodose plans were computed using TG-43 formalism with no heterogeneity corrections. RESULTS Shifts and tilts of the plaque ranged from 1.4 to 8.6 mm and 1.0 to 3.8 mm, respectively. V100 was ≥97% for 4 patients. Dmin for preplans and postplans ranged from 83 to 118 Gy and 45 to 110 Gy, respectively. Point doses for tumor apex and base were all found to decrease from the preimplant to the postimplant plan, with mean differences of 16.7 ± 8.6% and 30.5 ± 11.3%, respectively. CONCLUSIONS By implementing MRI for EPB, we eliminate reliance on approximations of the eye and tumor shape and the assumption of idealized plaque placement. With MRI, one can perform preimplant as well as postimplant imaging, facilitating EPB treatment planning based on the actual patient-specific geometry and dose-delivery verification based on the imaged plaque position.
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Affiliation(s)
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | | | - Vivian Rodriguez
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Carol G Bertelsman
- Department of Radiation Oncology, Barnes Jewish Hospital, Saint Louis, MO
| | - Stacie Mackey
- Department of Radiation Oncology, Barnes Jewish Hospital, Saint Louis, MO
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ
| | - H Michael Gach
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO; Department of Radiology, Washington University School of Medicine, Saint Louis, MO
| | - P Kumar Rao
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
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Karlovits S, Verstraeten T. Ocular Brachytherapy. Brachytherapy 2016. [DOI: 10.1007/978-3-319-26791-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Krohn J. A Modified Dummy Plaque for the Accurate Placement of Ruthenium-106 Plaques in Brachytherapy of Intraocular Tumours. Ocul Oncol Pathol 2015; 2:1-4. [PMID: 27172165 DOI: 10.1159/000381810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To present a new technique to ensure the correct positioning of ruthenium plaques in episcleral brachytherapy. MATERIALS AND METHODS An acrylic dummy plaque is made opaque by sanding both sides with sandpaper, and its edge is covered by a black marking tape. This modified plaque is temporarily sutured to the sclera overlying the choroidal tumour site. The tip of an endoillumination probe is placed at the anterior edge of the plaque, yielding a strong light scattering within the opaque acrylic material. Due to the light-absorbing tape around the plaque border, the scattered light is confined within the plaque, and its perimeter can be observed by indirect ophthalmoscopy as a circle of transilluminated light surrounding the tumour. When the correct position has been found, the dummy plaque is replaced by a ruthenium-106 plaque. RESULTS The technique was successfully applied in 5 patients with posterior choroidal melanoma. Compared to standard focal transillumination, its main advantage is that the position of the entire plaque and tumour can be observed simultaneously in one field without any movement or manipulation of the light probe or plaque. CONCLUSION The described transillumination technique and modified dummy plaque facilitate the correct positioning of ruthenium plaques in brachytherapy of choroidal melanoma.
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Affiliation(s)
- Jørgen Krohn
- Section of Ophthalmology, Department of Clinical Medicine, University of Bergen, and Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
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Dong Y, Chang Z, Xie G, Whitehead G, Ji JX. Susceptibility-based positive contrast MRI of brachytherapy seeds. Magn Reson Med 2014; 74:716-26. [DOI: 10.1002/mrm.25453] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/29/2014] [Accepted: 08/23/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Ying Dong
- Department of Electrical and Computer Engineering; Texas A&M University; College Station Texas USA
| | - Zheng Chang
- Department of Radiation Oncology; Duke University; Durham North Carolina USA
| | - Guoxi Xie
- Paul C. Lauterbur Research Center for Biomedical Imaging; Chinese Academy of Sciences; Shenzhen China
- Beijing Center for Mathematics and Information Interdisciplinary Sciences; Beijing China
| | - Gregory Whitehead
- Department of Electrical and Computer Engineering; Texas A&M University; College Station Texas USA
| | - Jim X. Ji
- Department of Electrical and Computer Engineering; Texas A&M University; College Station Texas USA
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Chiu-Tsao ST, Astrahan MA, Finger PT, Followill DS, Meigooni AS, Melhus CS, Mourtada F, Napolitano ME, Nath R, Rivard MJ, Rogers DWO, Thomson RM. Dosimetry of (125)I and (103)Pd COMS eye plaques for intraocular tumors: report of Task Group 129 by the AAPM and ABS. Med Phys 2012; 39:6161-84. [PMID: 23039655 DOI: 10.1118/1.4749933] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Dosimetry of eye plaques for ocular tumors presents unique challenges in brachytherapy. The challenges in accurate dosimetry are in part related to the steep dose gradient in the tumor and critical structures that are within millimeters of radioactive sources. In most clinical applications, calculations of dose distributions around eye plaques assume a homogenous water medium and full scatter conditions. Recent Monte Carlo (MC)-based eye-plaque dosimetry simulations have demonstrated that the perturbation effects of heterogeneous materials in eye plaques, including the gold-alloy backing and Silastic insert, can be calculated with reasonable accuracy. Even additional levels of complexity introduced through the use of gold foil "seed-guides" and custom-designed plaques can be calculated accurately using modern MC techniques. Simulations accounting for the aforementioned complexities indicate dose discrepancies exceeding a factor of ten to selected critical structures compared to conventional dose calculations. Task Group 129 was formed to review the literature; re-examine the current dosimetry calculation formalism; and make recommendations for eye-plaque dosimetry, including evaluation of brachytherapy source dosimetry parameters and heterogeneity correction factors. A literature review identified modern assessments of dose calculations for Collaborative Ocular Melanoma Study (COMS) design plaques, including MC analyses and an intercomparison of treatment planning systems (TPS) detailing differences between homogeneous and heterogeneous plaque calculations using the American Association of Physicists in Medicine (AAPM) TG-43U1 brachytherapy dosimetry formalism and MC techniques. This review identified that a commonly used prescription dose of 85 Gy at 5 mm depth in homogeneous medium delivers about 75 Gy and 69 Gy at the same 5 mm depth for specific (125)I and (103)Pd sources, respectively, when accounting for COMS plaque heterogeneities. Thus, the adoption of heterogeneous dose calculation methods in clinical practice would result in dose differences >10% and warrant a careful evaluation of the corresponding changes in prescription doses. Doses to normal ocular structures vary with choice of radionuclide, plaque location, and prescription depth, such that further dosimetric evaluations of the adoption of MC-based dosimetry methods are needed. The AAPM and American Brachytherapy Society (ABS) recommend that clinical medical physicists should make concurrent estimates of heterogeneity-corrected delivered dose using the information in this report's tables to prepare for brachytherapy TPS that can account for material heterogeneities and for a transition to heterogeneity-corrected prescriptive goals. It is recommended that brachytherapy TPS vendors include material heterogeneity corrections in their systems and take steps to integrate planned plaque localization and image guidance. In the interim, before the availability of commercial MC-based brachytherapy TPS, it is recommended that clinical medical physicists use the line-source approximation in homogeneous water medium and the 2D AAPM TG-43U1 dosimetry formalism and brachytherapy source dosimetry parameter datasets for treatment planning calculations. Furthermore, this report includes quality management program recommendations for eye-plaque brachytherapy.
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Nag S, Quivey JM, Earle JD, Followill D, Fontanesi J, Finger PT. The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas. Int J Radiat Oncol Biol Phys 2003; 56:544-55. [PMID: 12738332 DOI: 10.1016/s0360-3016(03)00006-3] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This article presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with choroidal melanomas. METHODS Members of the ABS with expertise in choroidal melanoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. RESULTS Episcleral plaque brachytherapy is a complex procedure and should only be undertaken in specialized medical centers with expertise in this sophisticated treatment program. Recommendations were made for patient selection, techniques, dose rates, and dosages. Most patients with very small uveal melanomas (<2.5 mm height and <10 mm in largest basal dimension) should be observed for tumor growth before treatment. Patients with a clinical diagnosis of medium-sized choroidal melanoma (between 2.5 and 10 mm in height and <16 mm basal diameter) are candidates for episcleral plaques if the patient is otherwise healthy and without metastatic disease. A histopathologic verification is not required. Small melanomas may be candidates if there is documented growth; some patients with large melanomas (>10 mm height or >16 mm basal diameter) may also be candidates. Patients with large tumors or with tumors at peripapillary and macular locations have a poorer visual outcome and lower local control that must be taken into account in the patient decision-making process. Patients with gross extrascleral extension, ring melanoma, and tumor involvement of more than half of the ciliary body are not suitable for plaque therapy. For plaque fabrication, the ophthalmologist must provide the tumor size (including basal diameters and tumor height) and a detailed fundus diagram. The ABS recommends a minimum tumor (125)I dose of 85 Gy at a dose rate of 0.60-1.05 Gy/h using AAPM TG-43 formalism for the calculation of dose. NRC or state licensing guidelines regarding procedures for handling of radioisotopes must be followed. CONCLUSIONS Brachytherapy represents an effective means of treating patients with choroidal melanomas. Guidelines are established for the use of brachytherapy in the treatment of choroidal melanomas. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose reporting policies. These guidelines will be modified as further clinical results become available.
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Affiliation(s)
- Subir Nag
- Department of Radiation Oncology, Ohio State University, Columbus, OH 43210, USA.
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Finger PT, Iezzi R, Esteveo ML, Szechter A, Rosen RB, Berson A. Diode-light transillumination for ophthalmic plaque localization around juxtapapillary choroidal melanomas. Int J Radiat Oncol Biol Phys 1999; 44:887-90. [PMID: 10386646 DOI: 10.1016/s0360-3016(99)00064-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE An evaluation of plaque-mounted diode-light transillumination (DLT) for localization of episcleral plaques beneath juxtapapillary tumors. METHODS AND MATERIALS Two patients scheduled for radiotherapy for juxtapapillary melanomas were offered DLT as an additional method of ophthalmic plaque localization. Plaques were constructed by affixing 4 non-heat producing, light-emitting diodes with their apertures flush with the episcleral outer surface of the plaque's rim. Bio-implantable epoxy was used to encapsulate the electronic components. Then the plaques were loaded with 103Pd seeds. After the eye-plaques were sewn to the episclera covering the base of the intraocular tumors; the diode-lights were illuminated, viewed and recorded. Photodocumentation of the relative position of the 4 lights around tumor's base was obtained in both cases. RESULTS Digital images of plaque-mounted diode retro-transillumination were obtained. No evidence of diode-light toxicity was noted. Both tumors were found to be covered by the ophthalmic plaques. CONCLUSION Juxtapapillary tumors are often difficult or impossible to visualize with standard transillumination techniques and have been associated with poor local control rates. We have developed plaque-mounted DLT in an effort to improve ophthalmic plaque localization. Retrobulbar transillumination was viewed by indirect ophthalmoscopy and recorded with video-imaging. This technique provides unique photographic documentation of episcleral plaque localization beneath juxtapapillary tumors.
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Affiliation(s)
- P T Finger
- The Ocular Tumor Service, Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, USA
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