Dose Distributions and Treatment Margins in Ocular Brachytherapy with 106Ru Eye Plaques

Stöckel, Erik; Eichmann, Marion; Flühs, Dirk; Sommer, H; Biewald, Eva; Bornfeld, Norbert; Spaan, B.; Sauerwein, W.

doi:10.1159/000479558

Cited by 27 publications

(29 citation statements)

References 18 publications

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“…Prescription procedures for Ru-106 treatments remain controversial [20]. Some centres use an apical prescribed dose of 85 Gy [1,24], some use 100 Gy to the apex [2,13], while others use at least 130 Gy to the apex along with restricted tumour base doses of at least 700 Gy [27]. Eccentrically located plaques are also reported frequently in the literature, and studies have indicated that this strategy can spare healthy tissue in some cases [5].…”

Section: Discussionmentioning

confidence: 99%

Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Espensen

Appelt

Fog

et al. 2019

Cancers

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Ruthenium-106 (Ru-106) brachytherapy is an established modality for eye-preserving treatment of choroidal melanoma. To achieve optimal treatment outcomes, there should be a balance between tumour control and the risk of healthy tissue toxicity. In this retrospective study, we examined normal tissue complication probability (NTCP) for visual acuity deterioration and late complications to aid the understanding of dose-dependence after Ru-106 treatments. We considered consecutive patients diagnosed with choroidal melanoma and primarily treated at a single institution from 2005–2014. Treatment plans were retrospectively recreated using dedicated software and image guidance to contour the tumour and determine the actual plaque position. Dose distributions were extracted from each plan for all relevant anatomical structures. We considered visual acuity deterioration and late complications (maculopathy, optic neuropathy, ocular hypertension, vascular obliteration, cataract and retinal detachment). Lasso statistics were used to select the most important variables for each analysis. Outcomes were related to dose and clinical characteristics using multivariate Cox regressions analysis. In total, 227 patients were considered and 226 of those were eligible for analysis. Median potential follow-up time was 5.0 years (95% CI: 4.5–6.0). Visual acuity deterioration was related to optic disc-tumour distance and dose metrics from the retina and the macula, with retina V10Gy showing the strongest correlation. Macula V10Gy was the only dose metric impacting risk of maculopathy, while optic disc-tumour distance also proved important. Optic disc V50Gy had the largest impact on optic neuropathy along with optic disc-tumour distance. Optic disc V20Gy was the only variable associated with vascular obliteration. Lens D2% had the largest impact on the risk of cataract along with older age and the largest base dimension. We found no variables associated with the risk of ocular hypertension and retinal detachment. Visual acuity deterioration and most late complications demonstrated dependence on dose delivered to healthy structures in the eye after Ru-106 brachytherapy for choroidal melanomas.

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Section: Discussionmentioning

confidence: 99%

Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Espensen

Appelt

Fog

et al. 2019

Cancers

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“…No obstante, dosis menores de 50 Gy se asocian con fallos significativos en el control local de la enfermedad. En los resultados del Collaborative Ocular Melanoma Study (COMS), en el que se han utilizado placas oculares de 125 I, se especificó una dosis mínima obligatoria de 85 Gy para aplicar a todo el volumen objetivo [9]. Se recomienda tratar el tumor con una tasa de dosis comprendida entre 0,60 y 1,05 Gy/h, es decir, con una aplicación del implante durante un periodo que varía entre tres y siete días.…”

Section: La International Commission On Radiation Units Andunclassified

“…Localización del tumor en diagrama de retina Ser vicio Geológico C olombiano secos se encargan de mediar los movimientos de aducción, abducción, elevación, descenso, rotación medial y rotación lateral del globo ocular [13], y, aunque son mínimos, no se pueden despreciar. Por esta razón, se debe agregar un margen de tratamiento de radioterapia adicional (o margen de seguridad) al CTV definido [9]. Cabe resaltar que en este tipo de técnica no se incluye el término de volumen objetivo de planeación (PTV, sigla de planning target volume), debido a que en este término se tienen en cuenta factores de incertidumbre relacionados con el margen de la enfermedad subclínica, como los movimientos involuntarios (respiración) y errores en el posicionamiento.…”

Section: Distribución De Dosisunclassified

Braquiterapia oftálmica de baja tasa de dosis en el Instituto Nacional de Cancerología, E. S. E.

Simbaqueba

Montúfar

2020

rev. investig. apl. nucl.

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La braquiterapia de baja tasa de dosis (LDR, por sus siglas en inglés), como opción de tratamiento contra el cáncer en el Instituto Nacional de Cancerología (INC), es una modalidad que usa radiaciones ionizantes para destruir células malignas y reducir el tamaño tumoral. Esta técnica de tratamiento consiste en la aplicación de semillas de iodo 125 (125I), elemento radiactivo que se dispone en una placa metálica de oro que se posiciona quirúrgicamente en la superficie del globo ocular en contacto con el tumor, con el fin de obtener un óptimo control local de los melanomas del cuerpo uveal y los retinoblastomas en pacientes pediátricos, cuando este tipo de neoplasias se encuentran en estadios tempranos, como una terapia alternativa a la enucleación (extirpación completa del globo ocular). En el presente artículo se describe la técnica usada en el INC, que se ha implementado desde el año 2006 empleando el software Plaque Simulator de BEBIG, se hace un barrido de la anatomía del globo ocular, las características físicas del radionúclido de 125I, el procedimiento clínico, la técnica, la planeación dosimétrica y la protección radiológica, dejando finalmente unos tópicos de discusión en las conclusiones.

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“…Из органосохраняющих методов лечения брахитерапия (БТ) с использованием различных радиоизотопов на протяжении полувека продолжает занимать лидирующую позицию и заслуженно считается «золотым стандартом» в схеме ведения больных данного профиля [2]. Использование контактных радиоактивных офтальмоаппликаторов (ОА) позволяет локально облучить опухоль, сохранить больному глаз, остаточное зрение и сохранить качество жизни [3].…”

Section: Introductionunclassified

Сombined Treatment of Juxtaand Parapapillary Choroidal Melanoma

et al. 2020

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Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up. Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months). Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %). Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.

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Dose Distributions and Treatment Margins in Ocular Brachytherapy with 106Ru Eye Plaques

Cited by 27 publications

References 18 publications

Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Predicting Visual Acuity Deterioration and Radiation-Induced Toxicities after Brachytherapy for Choroidal Melanomas

Braquiterapia oftálmica de baja tasa de dosis en el Instituto Nacional de Cancerología, E. S. E.

Сombined Treatment of Juxtaand Parapapillary Choroidal Melanoma

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