Eye retention after proton beam radiotherapy for uveal melanoma

Egger, Emmanuel; Zografos, Léonidas; Schalenbourg, Ann; Beati, D.; Bhringer, Terence; Chamot, Line; Goitein, Gudrun

doi:10.1016/s0360-3016(02)04200-1

Cited by 230 publications

(164 citation statements)

References 18 publications

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“…This compares to secondary enucleation rates of 9% reported by Gragoudas, 3 9.4% by Damato 4 and almost 14% reported by Egger et al 10 years after proton beam radiotherapy. 11 Wackernagel et al report an enucleation rate of 14% following stereotactic radiosurgery. 12 In conclusion our results add to evidence of the efficacy of both stereotactic radiosurgery and proton beam therapy in the management of posterior uveal melanoma with comparable rates of local control and eye retention between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma

Sikuade

Salvi

Rundle

et al. 2015

Eye

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Aim To present our experience of the use of stereotactic radiosurgery and proton beam therapy to treat posterior uveal melanoma over a 10 year period. Methods and materials Case notes of patients treated with stereotactic radiosurgery (SRS), or Proton beam therapy (PBT) for posterior uveal melanoma were reviewed. Data collected included visual acuity at presentation and final review, local control rates, globe retention and complications. We analysed post-operative visual outcomes and if visual outcomes varied with proximity to the optic nerve or fovea. Results 191 patients were included in the study; 85 and 106 patients received Stereotactic radiosurgery and Proton beam therapy, respectively. Mean follow up period was 39 months in the SRS group and 34 months in the PBT group. Both treatments achieved excellent local control rates with eye retention in 98% of the SRS group and 95% in the PBT group. The stereotactic radiosurgery group showed a poorer visual prognosis with 65% losing more than 3 lines of Snellen acuity compared to 45% in the PBT group. 33% of the SRS group and 54% of proton beam patients had a visual acuity of 6/60 or better. Conclusions Stereotactic radiosurgery and proton beam therapy are effective treatments for larger choroidal melanomas or tumours unsuitable for plaque radiotherapy. Our results suggest that patients treated with proton beam therapy retain better vision postoperatively; however, possible confounding factors include age, tumour location and systemic co-morbidities. These factors as well as the patient's preference should be considered when deciding between these two therapies.

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Section: Discussionmentioning

confidence: 99%

Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma

Sikuade

Salvi

Rundle

et al. 2015

Eye

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“…The position of the eye is fixed according to the location of the tumour by fixing the contralateral eye on a specified point. Doses of 60 Gy in four fractions 38,39 and 70 Gy in five fractions 40 have been used. This latter dose has been reduced to 50 Gy also in five fractions, but without any significant difference in either local control or complications.…”

Section: Radiotherapy For Ocular Tumours C Stannard Et Almentioning

confidence: 99%

“…39 Local control with protons is about 95% in most series. [38][39][40] Stereotactic RT with a g knife started with 55 Gy in one fraction, reducing slowly over several years of experience to 31 Gy. With a stereotactic linear accelerator, 60-70 Gy in five fractions was given but this was then reduced to 50 Gy.…”

Section: Radiotherapy For Ocular Tumours C Stannard Et Almentioning

confidence: 99%

Radiotherapy for ocular tumours

Stannard

Sauerwein

Maree

et al. 2012

Eye

104

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Ocular tumours present a therapeutic challenge because of the sensitive tissues involved and the necessity to destroy the tumour while minimising visual loss. Radiotherapy (RT) is one of several modalites used apart from surgery, laser, cryotherapy, and chemotherapy. Both external beam RT (EBRT) and brachytherapy are used. Tumours of the bulbar conjunctiva, squamous carcinoma and malignant melanoma, can be treated with a radioactive plaque: strontium-90, ruthenium-106

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“…24 A large retrospective analysis from the Paul Scherrer Institut (PSI) reported excellent eye-retention outcomes, with an overall rate of 83.7 at 15 years. 25 After optimization of the treatment technique the 5-year eye-retention rate was raised from 97.1% to 100% in small tumors, from 86.7% to 99.7% in medium, and from 71.1% to 89.5% in large tumors.…”

Section: Uveal Melanomamentioning

confidence: 99%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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Several model studies have shown potential clinical advantages with charged particles (protons and light ions) compared with 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in many disease sites. The newly developed intensity-modulated proton therapy (IMPT) often yields superior dose distributions to photon IMRT, with the added advantage of a significant reduction in the volume of healthy normal tissues exposed to low-to-medium doses. Initially, the major emphasis in clinical research for proton and light ion therapy was dose escalation for inherently radioresistant tumors, or for lesions adjacent to critical normal structures that constrained the dose that could be safely delivered with conventional x-ray therapy. Since the advent of IMRT the interest in particle therapy has gradually shifted toward protocols aimed at morbidity reduction. Lately the emphasis has mostly been placed on the potential for reduced risk of radiation-induced carcinogenesis with protons. Compared with 3D-CRT, a 2-fold increase has been theoretically estimated with the use of IMRT due to the larger integral volumes. In the pediatric setting, due to a higher inherent susceptibility of tissues, the risk could be significant, and the benefits of protons have been strongly emphasized in the literature. There is a significant expansion of particle therapy facilities around the world. Increasing public awareness of the potential benefits of particle therapy and wider accessibility for patients require that treating physicians stay abreast of the clinical indications of this radiotherapy modality. The article reviews the available literature for various disease sites in which particle therapy has traditionally been considered to offer clinical advantages and to highlight current lines of clinical research. The issue of radiation-induced second malignancies is examined in the light of the controversial epidemiological evidence available. The cost-effectiveness of particle therapy is also discussed. Cancer 2007;109: 1227-38. 2007 American Cancer Society.KEYWORDS: radiotherapy, proton therapy, light ions, intensity modulated radiotherapy, second cancers. C harged particles (protons and light ions) have a finite range in tissues. The interaction probability to cause ionization increases as they lose velocity traversing through tissues, so that a peak of dose occurs at a depth proportional to the energy of each particle. Beyond this peak no further dose deposition occurs. This phenomenon was described by William Bragg over 100 years ago.1 The dose peak may be 'spread out' to achieve a plateau of uniform dose to precisely cover the target while sparing adjacent normal structures. Passively scattered beams of a certain aperture can be produced by means of range-shifting modulators of variable thickness providing spread-out Bragg peaks (SOBP) for clinical use. The recent introduction of the spot scanning method represents a major advance in particle therapy.2 In this method, small pencil beams of a certain

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Eye retention after proton beam radiotherapy for uveal melanoma

Cited by 230 publications

References 18 publications

Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma

Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma

Radiotherapy for ocular tumours

Current status of radiotherapy with proton and light ion beams

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