Local tumour control and eye preservation after gamma-knife radiosurgery of choroidal melanomas

Wackernagel, Werner; Holl, Etienne; Tarmann, Lisa; Mayer, Christoph; Avian, Alexander; Schneider, M.; Kapp, Karin S.; Langmann, G.

doi:10.1136/bjophthalmol-2013-304031

Cited by 31 publications

(29 citation statements)

References 25 publications

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“…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. Comparing the visual outcome for these two treatment modalities, our results suggests patients treated with proton beam therapy retain better vision post-operatively however possible confounding factors in our study include age, tumour location and systemic co-morbidities.…”

Section: Discussionsupporting

confidence: 66%

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: Discussionsupporting

confidence: 66%

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 majority of patients treated for primary ocular malignancy were followed for a significantly longer period of time, extending as far out as 6 years posttreatment. In many cases, this is adequate time to evaluate the rate of enucleation, mucositis, xerophthalmus, and other toxicities assessed in this study [3,8,9]. …”

Section: Discussionmentioning

confidence: 99%

“…In addition, treatment strategies for melanoma and orbital malignancies have changed significantly over the past few decades [8,10]. Initial results utilizing GKR demonstrated good local control, but also resulted in a significant rate of neovascular glaucoma and other toxicities [10,11,12,13].…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Ocular Malignancies

Arnett

Reynolds

Pulido

et al. 2017

Stereotact Funct Neurosurg

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Background: Gamma knife radiosurgery (GKR) can be used for precise targeting of malignant lesions of the CNS when brachytherapy is not an appropriate option. Objectives: This study reports treatment technique, efficacy, and radiation-induced adverse effects in patients with primary and metastatic ocular lesions treated with Leksell GKR. Methods: A retrospective, single-institution review was conducted of 28 patients with primary or metastatic ocular disease, treated from 2000 to 2014. The dose to margin was 17-27 Gy (maximum dose 28-54 Gy). Primary outcomes included overall survival (OS), local control, progression-free survival (PFS), and enucleation. Results: The median age at diagnosis was 70 years, and the median follow-up was 26.4 months. Of the 28 patients, 11 (39%) had metastatic ocular disease, and 17 (61%) were diagnosed with primary ocular melanoma (stage T2a-T4e). The average maximum dose and dose to margin were 41 and 21 Gy, respectively. The mean dose to the optic nerve was 12.6 Gy. The 5-year OS was 46% (95% CI: 23.6-68.4%) for the entire cohort; the 5-year PFS for M0 patients who presented with primary ocular melanoma lesions was 90% (95% CI: 71-100%). Only 1 patient required enucleation after radiation treatment. Conclusion: GKR is an effective option, with acceptable levels of toxicity, in the treatment of primary and metastatic ocular lesions.

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“…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).…”

Section: Definitive Rt For Ocular Melanomasmentioning

confidence: 99%

Radiation Therapy for Melanoma

Shi

2017

Cutaneous Melanoma: Etiology and Therapy

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Although melanoma is a relative radioresistant tumor, radiation therapy (RT) remains a valid and effective treatment option for the management of melanoma. RT as a primary treatment is often offered in well-defined situations, such as medical inoperability, lentiginous melanoma, mucosal melanoma, and ocular melanoma. Adjuvant RT following lymphadenectomy in node-positive melanoma patients prevents local and regional recurrence; however, the role of adjuvant RT remains controversial and underutilized due to lack of overall survival benefit. On the other hand, RT is highly effective in providing symptom palliation for metastatic melanoma and is widely used. Advanced RT technologies such as stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) can achieve excellent local control with minimum toxicities. They are commonly used in the management of brain, lung, spine, and liver metastases. Most recently, it is under active investigation on combining RT with new systemic options, such as targeted therapy, or immunotherapy. The advancements in the treatment of patients with melanoma highlight the importance of multidisciplinary management in this disease. Radiation therapy will continue to be one of the key therapeutic options.

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Local tumour control and eye preservation after gamma-knife radiosurgery of choroidal melanomas

Cited by 31 publications

References 25 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

Gamma Knife Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Ocular Malignancies

Radiation Therapy for Melanoma

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