Preliminary Results of Uveal Melanoma Treated With Iodine-125 Plaques: Analysis of Disease Control and Visual Outcomes With 63 Gy to the Target Volume

Kheir, Wajiha Jurdi; Stinnett, Sandra S.; Meltsner, Sheridan; Semenova, Ekaterina A.; Mowery, Yvonne M.; Craciunescu, Oana; Kirsch, David G.; Materin, Miguel A.

doi:10.1016/j.adro.2021.100869

Cited by 3 publications

(4 citation statements)

References 36 publications

(66 reference statements)

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“…The standard COMS TG-43U calculations assume a homogenous water environment and do not account for a higher attenuation in the silastic material, and it has been shown that this can lead to a dose approximately 10% higher than calculated in a non-water attenuating material [ 23 , 24 ]. Our initial clinical outcomes with 63 Gy prescription with EP plaques was recently published [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…Decreasing dose to critical structures in the eye while maintaining margin coverage, especially for tumors near the optic nerve, is a topic of clinical interest, and has been attempted in the past by techniques including modifying COMS plaques [12], using differently designed plaques [13,14], and decreasing prescription doses [15][16][17][18]. Non-uniform loading to decrease dose to organs at risk (OARs) has been investigated with the use of COMS plaques [19], but due to significant dosimetric differences between COMS plaques and other plaque models, these results may not transfer to other types of eye plaques.…”

Section: Purposementioning

confidence: 99%

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Dual-source strength seed loading for eye plaque brachytherapy using eye physics eye plaques: A feasibility study

Meltsner¹,

Kirsch²,

Materin³

et al. 2022

jcb

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Purpose This study quantifies the dosimetric impact of incorporating two iodine-125 ( 125 I) seed source strengths in Eye Physics eye plaques for treatment of uveal melanoma. Material and methods Plaque Simulator was used to retrospectively plan 15 clinical cases of three types: (1) Shallow tumors (< 5.5 mm) with large base dimensions (range, 16-19 mm); (2) Tumors near the optic nerve planned with notched plaques; and (3) Very shallow (< 3.0 mm) tumors with moderate base dimensions (range, 13.5-15.5 mm) planned with larger plaques than requested by the ocular oncologist. Circular plaques were planned with outer ring sources twice the source strength of inner sources, and notched plaques with the six seeds closest to the notch at twice the source strength. Results In cases of type (1), the dual-source strength plan decreased prescription depth, and doses to critical structures were lower: inner sclera –25% ±2%, optic disc –7% ±3%, and fovea –6% ±3%. In four out of five cases of type (2), the dual-source strength plan decreased prescription depth, and dose to inner sclera was lower (–22% ±5%), while dose to optic disc (17% ±7%) and fovea (20% ±12%) increased. In cases of type (3), a smaller dual-source strength plaque was used, and scleral dose was lower (–45% ±3%), whereas dose to optic disc (1% ±14%) and fovea (5% ±5%) increased. Conclusions Dual-source strength loading as described in this study can be used to cover tumor margins and decrease dose to sclera, and therefore the adjacent retina, but can either decrease or increase radiation dose to optic disc and fovea depending on location and size of the tumor. This technique may allow the use of a smaller plaque, if requested by the ocular oncologist. Clinical determination to use this technique should be performed on an individual basis, and additional QA steps are required. Integrating the use of volumetric imaging may be warranted.

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Section: Methodsmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

Dual-source strength seed loading for eye plaque brachytherapy using eye physics eye plaques: A feasibility study

Meltsner¹,

Kirsch²,

Materin³

et al. 2022

jcb

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“…The outcomes from this 63 Gy dose level with this planning paradigm has since been published. 39 These more realistic dose distributions calculated in PS provides two types of dose histogram structures.The histogram primarily used in plan analysis and comparison is the Retinal Dose Area Histogram (RDAH). This is more useful because most structures of interest in the eye are located in its choroidal and retinal layers.…”

Section: Plaque Simulator Eye Model Image-based Planning Rdah/dvh And...mentioning

confidence: 99%

“…Figure 7 shows how prescribing to the tumor apex might not provide margin coverage. The outcomes from this 63 Gy dose level with this planning paradigm has since been published 39 …”

Section: Introductionmentioning

confidence: 99%

Transitioning from a COMS‐based plaque brachytherapy program to using eye physics plaques and plaque simulator treatment planning system: A single institutional experience

Meltsner

Rodrigues

Materin

et al. 2023

J Applied Clin Med Phys

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The aim of this work is to describe the implementation and commissioning of a plaque brachytherapy program using Eye Physics eye plaques and Plaque Simulator treatment planning system based on the experience of one institution with an established COMS-based plaque program. Although commissioning recommendations are available in official task groups publications such as TG-129 and TG-221, we found that there was a lack of published experiences with the specific details of such a transition and the practical application of the commissioning guidelines. The specific issues addressed in this paper include discussing the lack of FDA approval of the Eye Physics plaques and Plaque Simulator treatment planning system, the commissioning of the plaques and treatment planning system including considerations of the heterogeneity corrected calculations, and the implementation of a second check using an FDA-approved treatment planning system. We have also discussed the use of rental plaques, the analysis of plans using dose histograms, and the development of a quality management program. By sharing our experiences with the commissioning of this program this document will assist other institutions with the same task and act as a supplement to the recommendations in the recently published TG-221.

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Proton Therapy in Uveal Melanoma

Chan,

Lin,

Yacoub

et al. 2024

Cancers

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Background/Objectives: Uveal melanoma is the most common primary intraocular malignancy in adults. Treatment options for localized, early-stage disease include enucleation, brachytherapy, and proton beam therapy. This review aims to evaluate the role of proton therapy in the definitive management of uveal melanoma, focusing on its physics, radiobiology, treatment techniques, and associated outcomes. Methods: This narrative review synthesizes current literature on proton therapy for uveal melanoma, emphasizing case selection, treatment efficacy, and side effects. Results: Proton therapy offers significant advantages for thicker uveal melanomas (over 8 mm) due to its unique physical properties, including a rapid dose fall-off that protects critical structures like the retina and optic nerve. Proton therapy may have benefits in tumor control for ocular melanomas given its increased relative biological effectiveness relative to photon therapy for these typically more radioresistant melanomas. Proton therapy may also hold special value for uveal melanomas in close proximity to the optic nerve, as patients are at high risk of visual toxicities with brachytherapy. The review discusses the efficacy of proton therapy across small, medium, and large tumors, along with strategies for improving patient survival through combined systemic therapy. Additionally, the potential of ocular reirradiation with proton therapy is addressed. Conclusions: Proton therapy is an effective treatment for uveal melanoma. It offers advantages over brachytherapy for large tumors, tumors that are close to the optic nerve or insertion of extra-ocular muscles.

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Preliminary Results of Uveal Melanoma Treated With Iodine-125 Plaques: Analysis of Disease Control and Visual Outcomes With 63 Gy to the Target Volume

Cited by 3 publications

References 36 publications

Dual-source strength seed loading for eye plaque brachytherapy using eye physics eye plaques: A feasibility study

Dual-source strength seed loading for eye plaque brachytherapy using eye physics eye plaques: A feasibility study

Transitioning from a COMS‐based plaque brachytherapy program to using eye physics plaques and plaque simulator treatment planning system: A single institutional experience

Proton Therapy in Uveal Melanoma

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