Novel 3<scp>D</scp> conformal technique for treatment of choroidal melanoma with external beam photon radiotherapy

Phillips, Claire; Pope, Kathy; Hornby, Colin; Chesson, Brent; Cramb, Jim; Bressel, Mathias

doi:10.1111/1754-9485.12012

Cited by 4 publications

(8 citation statements)

References 19 publications

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“…The COMS results showed that patients with medium-sized CM did not have significantly different mortality rates at 12 years, irrespective of whether they were treated with PB or were subjected to enucleation. The apparent equivalence of treatments resulted in the exploration of episcleral PB, proton-beam treatment, and SRT as eye-preserving treatments [ 2 , 7 , 11 , 14 , 15 , 21 - 23 , 29 , 31 , 34 , 35 ]. Following COMS, medium-sized or smaller CMs are treated mainly with brachytherapy [ 14 , 22 ] while tumor control has been associated with a minimum dose to the tumor (Dmin) of 85 Gy delivered to the apex of the tumor as the gold standard [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Variations of these 3 treatment modalities are SRT and CPRT (which, in the case of OM, mainly refers to PBT), linear accelerator (LINAC)-based SFRT, and GK radiosurgery [ 13 - 15 , 17 ]. Today, RT has become the treatment of choice for medium-sized and symptomatic small CMs [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Charged particles and photon irradiation differ in that the first provokes a smaller exit dose through normal tissue as they stop abruptly in the tissue (Bragg peak; a peak on the plot of the energy loss of ionizing radiation beam versus the distance it travels through matter). CPT has yielded promising results in the treatment of juxtapupillary tumors [ 14 , 35 ]. Indeed, this group of treatment modalities showed low local failure rates.…”

Section: Discussionmentioning

confidence: 99%

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Radiation treatment methods in uveal melanoma

Tsotridou¹,

Loukovitis²,

Tsiropoulos³

et al. 2021

Med Hypothesis Discov Innov Ophthalmol

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Background: The most frequent primary ocular malignancy in the western world is the uveal melanoma. While it mainly affects Caucasians, it is extremely uncommon among non-Caucasians. Continuous improvement in therapies for local treatment has allowed sparing of the eye, although this approach apparently does not improve survival. The present review aimed to explain different radiotherapy (RT) methods and compare the pros and cons of each method, along with the main complications that may be encountered in the treatment of uveal melanoma. Methods: Relevant papers published in English between January 2010 and January 2021 were retrieved, reviewed, and screened. Four databases, including PubMed, MEDLINE, Google Scholar, and GeneCards, were searched for this purpose. Results: Forty-one relevant articles were identified. Based on the selected papers, we highlighted the advantages and disadvantages of the different RT methods that have allowed sparing of the eye, even though they have not, as yet, improved survival. We listed a detailed comparison between therapies that allow an educated choice among the different available RT methods. Conclusions: The choice of uveal melanoma management is determined by the location of the tumor and volume of the extraocular extent. At present, there is no gold standard for the management of all ocular melanomas, and each case should be approached individually. Therefore, classification is a valuable prognostic tool. Many cases in cT3-4 classification categories are treated by primary enucleation and conservative treatment follow-up, while in cT2 and most cT1 classifications (i.e., 3.1–6.0-mm tumor thickness), several forms of RT are used. Keywords: melanoma of the uvea, choroidal melanoma, radiation therapy, brachytherapy, radioisotope brachytherapy, proton beam therapy, classification

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Radiation treatment methods in uveal melanoma

Tsotridou¹,

Loukovitis²,

Tsiropoulos³

et al. 2021

Med Hypothesis Discov Innov Ophthalmol

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“…During the irradiation sessions, the head and eye must be carefully positioned. Although the efficacy seems to be similar to brachytherapy (59), there are major advantages due to more homogenous and focused treatment and less damage on the surrounding tissue (60). Still, radiation-associated complications can occur in time in almost 50% of the cases (61).…”

Section: Irradiation Therapiesmentioning

confidence: 99%

Uveal melanoma diagnosis and current treatment options (Review)

et al. 2021

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Uveal melanoma is a rare condition accounting for only 5% of all primary melanoma cases. Still, it is the most frequently diagnosed primary intraocular malignant tumor in adults. Almost 90% of the tumors involve the choroid and only a small percentage affects the ciliary body or the iris. There is a consistent difference in incidence between different regions with individuals of northern European descent having a significantly higher risk as compared to Hispanics, Asians, and Blacks. Among the many risk factors, mutations in the G protein subunit alpha Q (GNAQ) or G protein subunit alpha 11 (GNA11) genes and different receptors are highly suggestive. While iris melanoma can easily be noticed by the patient itself or diagnosed at a routine slit-lamp evaluation, a consistent percentage of posterior uveal tumors are incidentally diagnosed at funduscopic evaluation as they can evolve silently for years, especially if located in the periphery. Uveal melanoma classifications rely on the tumor size (thickness and basal diameter) and also on intraocular and extraocular extension. The differential diagnosis with pseudomelanomas is carried out according to the tumor aspect and position. Iris melanoma has a better prognosis and a lower mortality rate as compared to choroidal melanoma that has a much higher rate of metastasis (50% of the patients) and a subsequent limited life expectancy from 6 to 12 months. While conservative therapeutic options for the primary tumor, relying on different surgical excision techniques and/or irradiation therapies, offer good local tumor control, the treatment options for metastatic disease, although numerous, are still inadequate in preventing a fatal outcome.

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“…This type of approach requires the patient to gaze at the light source during each fraction of radiation delivery. Other tracking systems have also been proposed [1,2,27,34], which are mostly focused on the reproducible stereotactic frame and automatic real-time surveillance of the eye position. These approaches share a common feature that the monitoring system serves as a gating role for radiation delivery, i.e., if the captured eyeball information deviates out of a predefined range, an interruption signal will be sent to LINAC and the radiation beam will be paused.…”

Section: Introductionmentioning

confidence: 99%

A mechanical eyeball phantom for uveal melanoma radiosurgery by cyberknife

Chen

Hatoum

et al. 2014

J Radiat Oncol

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Objective A treatment option for uveal melanoma has been investigated using the Cyberknife system, due to its advantage of real-time image guidance during therapy. However, unpredictable eyeball movement imposes challenges to the state-ofart technology. As a solution, we derived a 2D/3D transformation algorithm that is based on the pupil's 2D coordinates captured by an optical tracking system to predict the tumor's 3D positions in real-time. In order to validate our developed algorithm and other methods, a mechanical phantom that can simulate the eyeball's movement is highly desirable. Methods We designed a mechanical phantom that consists of a camera module, an eyeball module with an embedded "tumor", an eyeball holder module, and an eyeball moving module. All materials are made with acrylic or nylon plastics with the exception of the linear motion stages and the camera. Results In the calibration procedure, the phantom is scanned using a CT scanner. By using the recorded pupil's coordinates and extracted tumor coordinates, the 2D/3D transformation model yields 0.39±0.09 mm root-sum-squared error for five calibration positions between the actual 3D coordinates and the predicted coordinates. In the validation procedure, the eyeball is rotated to 11 different positions through the mechanical phantom. The 2D/3D transformation model yields 0.58±0.27 mm root-sum-squared error for these positions between the Cyberknife-identified 3D coordinates and the predicted coordinates. The eyeball's position can be controlled within millimeter accuracy. Conclusion The designed mechanical phantom is suitable for validating image-guided radiosurgery methods. Further dynamic evaluations can confirm these methods for clinical applications.

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Novel 3D conformal technique for treatment of choroidal melanoma with external beam photon radiotherapy

Cited by 4 publications

References 19 publications

Radiation treatment methods in uveal melanoma

Radiation treatment methods in uveal melanoma

Uveal melanoma diagnosis and current treatment options (Review)

A mechanical eyeball phantom for uveal melanoma radiosurgery by cyberknife

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