Brachytherapy or enucleation in ring melanoma patients: which is better? Preliminary results of the authors’ own experiences

Markiewicz, Anna; Gerba-Górecka, Karolina; Jakubowska, Barbara; Bicka-Kumela, Magdalena De; Kowal, Joanna; Karska‐Basta, Izabella; Skórkiewicz, Konrad; Romanowska-Dixon, B.

doi:10.5114/jcb.2021.108598

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…In our analysis of a group of patients treated with this method, 56% had positive local outcomes of the treated tumor. Similar positive results of local treatment have been obtained with brachytherapy in a rare variety of uveal melanoma that is ring melanoma, where removal of the eyeball is the standard of treatment [16]. In three cases of recurrence, an increase in tumor thickness was observed; in the remaining one, the base of the tumor increased.…”

Section: Discussionsupporting

confidence: 67%

Ophthalmic applicator displacement as a method of treating large diffuse uveal melanomas

Markiewicz,

Skórkiewicz,

Bogdał

et al. 2023

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Purpose The presentation of results of an ophthalmic plaque displacement as a brachytherapy treatment method of large diffuse uveal melanomas. Material and methods This was a retrospective analysis of treatment results of 9 patients with large diffuse uveal melanomas using ophthalmic plaque displacement. Patients were treated with this method in our center between 2012 and 2021 (last follow-up visit in 2023). To achieve appropriate radiation dose distribution for large tumors with a base greater than 18 mm, brachytherapy ( 106 Ru in 7 patients and 125 I in 2 patients) with applicator displacement was used as primary treatment. Median follow-up was 2.9 years, and for patients with positive primary treatment results, it was 1.7 months. Median time to local relapse was 2.3 years. Results In 5 patients, a positive result of local treatment was obtained, out of whom, one patient underwent enucleation due to complications. In the next 4 cases, local recurrence developed. In all tumors, the use of applicator displacement method caused that planning target volume (PTV) was effectively covered with treatment isodose. Conclusions Brachytherapy with ocular applicator displacement allows for the treatment of tumors with base measurements larger than 18 mm. The application of this method may be considered as an alternative for eye enucleation in particular cases of large diffuse tumors, such as a neoplasm of the eye with vison, or when a patient does not consent to enucleation.

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Section: Discussionsupporting

confidence: 67%

Ophthalmic applicator displacement as a method of treating large diffuse uveal melanomas

Markiewicz,

Skórkiewicz,

Bogdał

et al. 2023

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“…In larger uveal ring melanoma studies (including ring melanomas of angle and ciliary body), the primary location of metastasis was through the hematogenous route to the liver (up to 100%), followed by bone (25%) and skin (8%). 2 , 4 , 6 It has been theorized that glaucoma surgery/procedures, such as filtering procedures, may allow a route of metastasis through the lymphatic drainage system, which is classically absent from intraocular structures. 24 , 25 The route of metastasis is presumed to be from invasion of emissary channels or the trabecular meshwork and subsequent drainage through the conjunctival/orbital lymphatic vessels.…”

Section: Discussionmentioning

confidence: 99%

“…Due to its rare entity, uveal ring melanoma descriptions have largely been limited to case reports and the largest study to date ( n = 49) was published by Markiewicz et al in 2001. 4 The characteristic circumferential pattern of growth means that tumor spread is typically insidious and tumor detection often occurs at an advanced stage. The primary presentation may occur due to secondary sequelae, such as refractory unilateral glaucoma, 5 – 7 hyphaema, 8 cataract, 2 or extraocular extension.…”

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confidence: 99%

Tumor Profiles of Late Presentation Uveal Ring Melanoma With Novel Characteristics – A Case Series

Lim,

Crawford,

McGhee

2023

Invest. Ophthalmol. Vis. Sci.

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Purpose The purpose of this study was to investigate the clinical features, tumor characteristics, including histopathology and cytogenetic analysis, and management of patients with uveal ring melanoma in New Zealand. Methods A retrospective review was conducted on all uveal melanoma cases treated in a single national oncology center in New Zealand. The study period was from January 1, 2013 to December 31, 2022 (10 years). Written consent was obtained from all patients included in this case series. Results Uveal ring melanoma of ciliary body origin ( n = 4) comprised 0.7% of all uveal melanomas ( n = 571). Ethnicity distribution was three patients of New Zealand European ancestry and one patient of Chinese/Pasifika ancestry. Three patients (75%) were symptomatic at presentation (spontaneous hyphema, glaucoma, and cataract), whereas one was asymptomatic but subsequently developed painful refractory glaucoma. All eyes underwent enucleation. Three eyes had primary iris biopsies with subsequent enucleation for refractory glaucoma and pain and one eye underwent primary enucleation. All cases demonstrated malignant tumor characteristics including diffuse 270 to 360-degree ciliary body ring growth pattern, epithelioid-cell type and presence of either BAP-1 expression loss or gain of MYC gene. Two cases (50%) developed distant organ metastasis – liver, parotid gland, and breast. Of those, one patient was deceased at the time of follow-up whereas one had completed treatment for metastases. Conclusions Uveal ring melanoma is a rare tumor that is highly invasive and malignant. When detected, prompt definitive treatment should be advocated, and patient counselling should be given regarding the high risk of developing a painful, blind eye with increased risk of metastasis in the absence of treatment.

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“…Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, with the highest incidence of 5-10 per million Whites per year. The eyeball is the most common extracutaneous location of melanoma [1][2][3][4][5][6][7][8]. Usually, it is located in the choroid (90%), and less often in the ciliary body (6%) and iris (4%) [9].…”

Section: Introductionmentioning

confidence: 99%

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

2023

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Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The eyeball is the most common extracutaneous location of melanoma. UM is a huge threat to a patient’s life. It metastasizes distantly via blood vessels, but it can also spread locally and infiltrate extraocular structures. The treatment uses surgical methods, which include, among others, enucleation and conservative methods, such as brachytherapy (BT), proton therapy (PT), stereotactic radiotherapy (SRT), stereotactic radiosurgery (SRS), transpupillary thermotherapy (TTT) and photodynamic therapy. The key advantage of radiotherapy, which is currently used in most patients, is the preservation of the eyeball with the risk of metastasis and mortality comparable to that of enucleation. Unfortunately, radiotherapy very often leads to a significant deterioration in visual acuity (VA) as a result of radiation complications. This article is a review of the latest research on ruthenium-106 (Ru-106) brachytherapy, iodine-125 (I-125) brachytherapy and proton therapy of uveal melanoma that took into account the deterioration of eye function after therapy, and also the latest studies presenting the new concepts of modifications to the applied treatments in order to reduce radiation complications and maintain better visual acuity in treated patients.

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Brachytherapy or enucleation in ring melanoma patients: which is better? Preliminary results of the authors’ own experiences

Cited by 5 publications

References 27 publications

Ophthalmic applicator displacement as a method of treating large diffuse uveal melanomas

Ophthalmic applicator displacement as a method of treating large diffuse uveal melanomas

Tumor Profiles of Late Presentation Uveal Ring Melanoma With Novel Characteristics – A Case Series

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

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