Plaque brachytherapy for posterior uveal melanoma in 2018

Reichstein, David; Karan, Kayla

doi:10.1097/icu.0000000000000468

Cited by 29 publications

(27 citation statements)

References 63 publications

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“…[5][6][7] The most common radiotherapy modalities employed in UM are plaque brachytherapy (PRXT) and proton beam radiotherapy (PBR). [7][8][9][10] Brachytherapy is most effective when used to treat small-to-medium sized UM where the thickness is ≤7 mm, 11 whereas PBR can be used to treat UM that are larger or closer to the optic disc and the fovea, taking advantage of the Bragg peak and utilising a modified beam structure. 12 Newer techniques, such as stereotactic radiosurgery with CyberKnife or Gamma Knife, achieve similar local control rates with eye retention to PBR but have a poorer visual prognosis post-treatment.…”

Section: Introductionmentioning

confidence: 99%

Effects of plaque brachytherapy and proton beam radiotherapy on prognostic testing: a comparison of uveal melanoma genotyped by microsatellite analysis

et al. 2020

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Background/aimsProton beam radiotherapy and plaque brachytherapy are commonly applied in primary uveal melanoma (UM); however, their effect on chromosome 3 classification of UM by microsatellite analysis (MSA) for prognostication purposes is unknown, where the tumour is sampled post-irradiation. This study examined the prognostic accuracy of genotyping UM biopsied before or after administration of radiotherapy, by MSA.Methods407 UM patients treated at the Liverpool Ocular Oncology Centre between January 2011 to December 2017, were genotyped for chromosome 3 by MSA; 172 and 176 primary UM were sampled prior to and post irradiation, respectively.ResultsGenotyping by MSA was successful in 396/407 (97%) of UM samples (196 males, 211 females; median age of 61 years (range 12 to 93) at primary treatment). There was no demonstrable association between a failure of MSA to produce a chromosome 3 classification and whether radiation was performed pre-biopsy or post-biopsy with an OR of 0.96 (95% CI 0.30 to 3.00, p=0.94). There was no evidence of association (measured as HRs) between risk of metastatic death and sampling of a primary UM before administration of radiotherapy (HR 1.1 (0.49 to 2.50), p=0.81). Monosomy 3 (HR 12.0 (4.1 to 35.0), p<0.001) was significantly associated with increased risk of metastatic death.Conclusions and relevanceThis study revealed that successful genotyping of UM using MSA is possible, irrespective of irradiation status. Moreover, we found no evidence that biopsy prior to radiotherapy increases metastatic mortality.

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Section: Introductionmentioning

confidence: 99%

Effects of plaque brachytherapy and proton beam radiotherapy on prognostic testing: a comparison of uveal melanoma genotyped by microsatellite analysis

et al. 2020

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“…Brachytherapy has become a common globe-sparing therapy for choroidal melanoma [50,51]. Using ruthenium-106 with its limited range of β-radiation, the irradiation dose is targeted at a restricted volume.…”

Section: Discussionmentioning

confidence: 99%

Blue-Light Fundus Autofluorescence Imaging following Ruthenium-106 Brachytherapy for Choroidal Melanoma

et al. 2020

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To describe changes in blue-light fundus autofluorescence (FAF) and corresponding alterations in optical coherence tomography (OCT) within the irradiation field after ruthenium-106 brachytherapy (RBT) for choroidal melanoma. Methods: Consecutive patients with choroidal melanoma were included in a retrospective case series. Patients were treated with RBT at a single institution. As part of their routine examination patients underwent multimodal imaging including ultrasonography, fundus photography, OCT, and FAF imaging (excitation = 488 nm). FAF images were analysed for changes within the irradiation field. Results: 31 patients (mean age 65.7 years) were treated with RBT for unilateral choroidal melanoma. Mean tumour height before therapy was 2.7 mm (SD 1.0). Mean follow-up time was 23.3 months (SD 13.3). Main FAF characteristics attributable to RBT emerged as increased FAF with speckled decreased FAF (FAF mottling) within the irradiation field and a rim of increased FAF at its border. OCT scans demonstrated loss of the ellipsoid zone and the external limiting membrane, thinning of the neurosensory retina, and alterations of the retinal pigment epithelium like clumping, migration, and atrophy. Conclusions: FAF changes in the irradiation field after RBT of choroidal melanomas follow a characteristic pattern that correlates with distinct OCT alterations. FAF and OCT imaging give additional information to monitor effects of RBT and, therefore, complement multimodal imaging techniques after plaque therapy.

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“…Plaque brachytherapy or plaque radiotherapy is the most widely used treatment modality in the management of UM and involves administration of a fixed dose of RT to the tumor. This is achieved by insertion of a radioactive implant into the episcleral tissue that delivers an apex RT dose of 80-100 Gy [18,19]. The most frequently employed radioisotope in the treatment of UM is Iodine-125 ( 125 I) owing to its favorable dosimetric profile, followed by Ruthenium-106 ( 106 Ru), and Palladium-103 ( 103 Pd) [20].…”

Section: Treatment Modalitiesmentioning

confidence: 99%

Clinical management of uveal melanoma: a comprehensive review with a treatment algorithm

et al. 2020

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Melanoma is a malignancy that originates from the neoplastic proliferation of melanin-producing cells known as melanocytes, which can be primarily found in the skin, ocular region and mucous membranes. Uveal melanoma (UM) is the most frequently occurring non-cutaneous melanoma and is the most common primary intraocular malignancy in adults [1]. The uveal tract, a layer underlying the sclera of the eye, includes the iris, ciliary body and choroid. Around 95% of uveal melanomas arise from the choroidal melanocytes. 1. Epidemiology The worldwide incidence of UM is estimated to be close to 4 to 5 Uveal melanoma (UM), the most frequently occurring non-cutaneous melanoma and most common primary intraocular malignancy in adults, arises from the melanocytes of the choroid in approximately 95% of cases. Prompt diagnosis and treatment is vital as primary tumor size is one of the key factors associated with survival. Despite recent advances in management, more than half of the patients develop metastatic disease which portends poor survival. Currently, treatment options for UM include local resection, enucleation, plaque brachytherapy, and/or particle beam radiotherapy (RT). Enucleation was initially the standard of care in the management of UM, but a shift towards eye-preserving therapeutic choices such as RT and local resection has been noted in recent decades. Plaque brachytherapy, a form of localized RT, is the most popular option and is now the preferred treatment modality for a majority of UM cases. In this review we discuss the etiopathogenesis, clinical presentation and diagnosis of UM and place a special emphasis on its therapeutic options. Furthermore, we review the current literature on UM management and propose a functional treatment algorithm for non-metastatic disease.

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Plaque brachytherapy for posterior uveal melanoma in 2018

Abstract: Plaque brachytherapy for uveal melanoma remains highly effective for local tumor control and prevention of metastasis. Indications for plaque brachytherapy have expanded, and the technique has improved.

Cited by 29 publications

References 63 publications

Effects of plaque brachytherapy and proton beam radiotherapy on prognostic testing: a comparison of uveal melanoma genotyped by microsatellite analysis

Effects of plaque brachytherapy and proton beam radiotherapy on prognostic testing: a comparison of uveal melanoma genotyped by microsatellite analysis

Blue-Light Fundus Autofluorescence Imaging following Ruthenium-106 Brachytherapy for Choroidal Melanoma

Clinical management of uveal melanoma: a comprehensive review with a treatment algorithm

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