Choroidal melanoma treated with stereotactic fractionated radiotherapy and prophylactic intravitreal bevacizumab: The Dunedin Hospital experience

Abstract

This study reaffirmed that SRT achieves very good local control and eye retention rates. PIB did not appear to reduce the radiation retinopathy rate in this study, and more studies are required especially Phase II and III trials to determine PIB efficacy in preventing RR.

The Burden of Histologically Confirmed Uveal Melanoma in Aotearoa-New Zealand: A 21-year Review of the National Cancer Registry

“…4,5,31,33,42,51 As astutely observed by Stang et al, 28 we do recognize that the current estimated incidence is likely to be an underestimate of the true incidence as an increasing amount of UM cases are being detected earlier and are likely smaller and therefore amenable to treatment with eye-preserving therapies such as with plaque brachytherapy, stereotactic radiotherapy, and proton beam radiotherapy. Indeed, in data extrapolated from published 23,24 and unpublished local audits, we estimate that there is an additional 28% of UM cases that were treated by plaque brachytherapy and stereotactic radiotherapy, treatment modalities that did not receive a histologic diagnosis before treatment. Furthermore, it is not currently a standard practice in NZ to obtain a prognostic tumor sample for eye-preserving therapies to reduce the risk of tumor seeding.…”

Radiation Therapy for Melanoma

“…Dose reduction may be important for toxicity reduction in particle therapy as it is in brachytherapy, and a prospective randomized trial of lower-dose (50 Gy) versus standard dose (70 Gy) proton radiation for small-to-moderate sized uveal melanoma showed no differences in a 5-year local or systemic recurrence or visual acuity loss, suggesting lower dose may be acceptable moving forward (44). In the past decade or two, linear accelerator (LINAC) stereotactic RT (SRT), or SRS with either LINAC or gamma knife has been investigated for its potential as an alternative option to proton beam (46)(47)(48)(49)(50)(51)(52)(53). The initial experiences showed that SRT and SRS offer a noninvasive alternative to enucleation and brachytherapy in the management of uveal melanoma, with similar outcome to proton beam therapy (46)(47)(48)(49)(50)(51)(52)(53).…”

Effectiveness of Anti-VEGF Treatment on Ophthalmic Radiation Side Effects

“…If this damage is left unrepaired, acute and chronic side effects are observed. Degree of the side effects occurring in the eye depends on the dose and energy of irradiation implemented and amount of the tissue exposed to irradiation (1–2–3).…”

“…Bevacizumab, an antiangiogenic agent, is a recombinant humanized monoclonal antibody that specifically binds to human VEGF, neutralizing biological activity. Topical and subconjunctival BV is widely used and reported to be effective in retina and choroid diseases progressing with neovascularization, age-related exudative macular degeneration, macular edema due to obstruction of the central retinal vein, diabetic retinopathy, and macular edema resulting from uveitis (1, 3–4–5).…”

“…Effectiveness of BV in treatment of the side effects occurring in the eye due to radiation has been researched for the last 3 years. It is thought that the clinical studies and animal models aiming at that purpose can be effective in treatment (3–4–5). In their study of radiotherapy-treated patients diagnosed with choroidal melanoma, Haji Mohd Yasin et al (3) compared the patients receiving or not receiving prophylactic intravesical BV together with stereotactic fractionated radiotherapy.…”