Proton Beam Irradiation of Uveal Melanomas: The First 30 Years The Weisenfeld Lecture

Gragoudas, Evangelos S.

doi:10.1167/iovs.06-0659

Cited by 104 publications

(73 citation statements)

References 99 publications

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“…We found that, in addition to exudative retinal detachment and intraocular haemorrhages, this NVG rate often results in poor function or enucleation. The same conclusions were reached by other authors, such as Gragoudas [2] , Boyd et al [3] and Foss et al [4] . Thus, further research is required to find new preventive treatments and enhance our results.…”

Section: Introductionsupporting

confidence: 88%

Treatment of Neovascular Glaucoma after Proton Therapy for Uveal Melanomas with Ranibizumab Injection: Preliminary Results

et al. 2011

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A last-chance intravitreal injection of ranibizumab was administered alone or in combination with cryotherapy before enucleation for 14 melanomas with neovascular glaucoma (NVG) after proton therapy. These patients were uncontrolled despite medical treatment and experienced pain. All of our patients had a minimum of 4 months of follow-up (ranging from 4 to 22 months). In all of the cases, the neovessels disappeared, and the intra-ocular pressure was normal for 11 out of the 14 patients with or without antiglaucoma drops. No patient experienced pain after the first injection. Tumour regression increased in some patients. However, thus far, the number of cases has been too small to perform any statistical analyses. Although very promising, our results are only preliminary.

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Section: Introductionsupporting

confidence: 88%

Treatment of Neovascular Glaucoma after Proton Therapy for Uveal Melanomas with Ranibizumab Injection: Preliminary Results

et al. 2011

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“…In their study, Missotten et al [22 ]found significantly elevated aqueous VEGF levels in eyes with uveal melanoma irrespective of the treatment compared with controls and eyes with a retinal detachment alone. The current literature shows overall 5-year neovascular glaucoma rates of approximately 11-31% in modern proton-treated uveal melanoma patients with neovascular glaucoma, and this typically occurs in the first 3 years after treatment [23,24,25]. In our study, the neovascular glaucoma rate was 20%, which was not higher than reported in the literature for uveal melanoma in general.…”

Section: Discussioncontrasting

confidence: 41%

Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

et al. 2014

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Background: Choroidal melanoma is frequently accompanied by an exudative retinal detachment that can persist after proton beam therapy. This study investigates whether vitrectomy without tumor resection improves the clinical outcome. Methods: This is a retrospective interventional case series. Twenty patients with choroidal melanoma with exudative retinal detachment involving the macula were treated by vitrectomy, endodrainage, photocoagulation, and silicone oil tamponade after proton beam therapy. Results: The mean follow-up was 38.4 months (median 21.5, range 12.0-122.0). The mean time between proton beam therapy and surgery was 4.5 months (range 0.1-9.2). Reattachment was achieved in 95% of the patients after one vitrectomy. One patient was lost to follow-up because enucleation was performed after 45.9 months due to a secondary glaucoma. Mean visual acuity decreased from 1.1 to 1.8 logMAR before vitrectomy and after 4 years, respectively. No patient showed local tumor recurrence. Metastatic disease was present in 1 patient after 15.2 months, and this patient died after 19.2 months. Conclusion: Vitrectomy is indicated after therapeutic proton beam irradiation in patients who present with persisting exudative retinal detachment involving the macula and high local or systemic risk factors for hemorrhagic complications, thus excluding endoresection.

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“…5,6 The 5 and 15 yr local control rates of 97% and 95%, respectively, [6][7][8][9] and overall survival rate of 80% were reported, which is comparable to the survival rates reported for enucleation. 10 The probability of eye retention at 5 yr was estimated to be 90% for the entire group.…”

Section: Introductionmentioning

confidence: 52%

Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

et al. 2010

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Purpose:The purpose of this study is to evaluate a novel approach for treatment planning using digital fundus image fusion in EYEPLAN for proton beam radiation therapy ͑PBRT͒ planning for ocular melanoma. The authors used a prototype version of EYEPLAN software, which allows for digital registration of high-resolution fundus photographs. The authors examined the improvement in tumor localization by replanning with the addition of fundus photo superimposition in patients with macular area tumors. Methods:The new version of EYEPLAN ͑v3.05͒ software allows for the registration of fundus photographs as a background image. This is then used in conjunction with clinical examination, tantalum marker clips, surgeon's mapping, and ultrasound to draw the tumor contour accurately. In order to determine if the fundus image superimposition helps in tumor delineation and treatment planning, the authors identified 79 patients with choroidal melanoma in the macular location that were treated with PBRT. All patients were treated to a dose of 56 GyE in four fractions. The authors reviewed and replanned all 79 macular melanoma cases with superimposition of pretreatment and post-treatment fundus imaging in the new EYEPLAN software. For patients with no local failure, the authors analyzed whether fundus photograph fusion accurately depicted and confirmed tumor volumes as outlined in the original treatment plan. For patients with local failure, the authors determined whether the addition of the fundus photograph might have benefited in terms of more accurate tumor volume delineation. Results: The mean follow-up of patients was 33.6Ϯ 23 months. Tumor growth was seen in six eyes of the 79 macular lesions. All six patients were marginal failures or tumor miss in the region of dose fall-off, including one patient with both in-field recurrence as well as marginal. Among the six recurrences, three were managed by enucleation and one underwent retreatment with proton therapy. Three patients developed distant metastasis and all three patients have since died. The replanning of six patients with their original fundus photograph superimposed showed that in four cases, the treatment field adequately covered the tumor volume. In the other two patients, the overlaid fundus photographs indicated the area of marginal miss. The replanning with the fundus photograph showed improved tumor coverage in these two macular lesions. For the remaining patients without local failure, replanning with fundus photograph superimposition confirmed the tumor volume as drawn in the original treatment plan. Conclusions: Local control was excellent in patients receiving 56 GyE of PBRT for uveal melanomas in the macular region, which traditionally can be more difficult to control. Posterior lesions are better defined with the additional use of fundus image since they can be difficult to mark surgically. In one-third of treatment failing patients, the superposition of the fundus photograph would have clearly allowed improved localization of tumor. The current practice s...

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Proton Beam Irradiation of Uveal Melanomas: The First 30 Years The Weisenfeld Lecture

Cited by 104 publications

References 99 publications

Treatment of Neovascular Glaucoma after Proton Therapy for Uveal Melanomas with Ranibizumab Injection: Preliminary Results

Treatment of Neovascular Glaucoma after Proton Therapy for Uveal Melanomas with Ranibizumab Injection: Preliminary Results

Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

Fundus image fusion in EYEPLAN software: An evaluation of a novel technique for ocular melanoma radiation treatment planning

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