Robotic CyberKnife Radiosurgery for Ciliary Body Melanoma

Liegl, Raffael; Schmelter, Valerie; Fuerweger, Christoph; Foerster, Michael; Muacevic, Alexander; Priglinger, Siegfried; Schaller, U. C.; Foerster, Paul

doi:10.1016/j.oret.2020.03.031

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Hence, we specifically analyzed the treatment planning procedures and treatment regimen as influence factors for local recurrence in our study population. We previously found local control rates for ciliary body melanomas treated with 18–22 Gy at a 70% isodose to be 85% after 3 years [26]. Interestingly, there was a significant difference between patients treated with a prescription dose of 21 Gy (local control rate 90.5%) and patients treated with a prescription dose of 20 Gy or less (local control rate 71%) [26].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with significantly better visual acuity received repeat CyberKnife treatment as salvage therapy and showed an eye retention rate of 81% despite local recurrence. Over the past years, we went through a constant learning progress that led to the use of radiation doses of minimum 21 Gy [26], proper planning of treatment including contrast-based MRIs, ultra-widefield photo documentation of tumor delineation, and sufficient safety distance around the tumor edges to increase local control. In this manner, we were able to increase local control as described in details, elsewhere [26].…”

Section: Discussionmentioning

confidence: 99%

“…We previously found local control rates for DOI: 10.1159/000527915 ciliary body melanomas treated with 18-22 Gy at a 70% isodose to be 85% after 3 years [26]. Interestingly, there was a significant difference between patients treated with a prescription dose of 21 Gy (local control rate 90.5%) and patients treated with a prescription dose of 20 Gy or less (local control rate 71%) [26]. Thus, we declare a prescription dose of less than 21 Gy as insufficient from today's point of view.…”

Section: Discussionmentioning

confidence: 99%

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Local Recurrence in Choroidal Melanomas following Robotic-Assisted Radiosurgery (CyberKnife)

et al. 2022

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Background: Tumor recurrence in choroidal melanoma has been associated with decreased overall survival due to metastatic spreading. To detect risk factors of local recurrence and side effects, we analyzed tumor planning and treatment parameters in patients with recurrence of choroidal melanoma after treatment with robotic-assisted radiosurgery (CyberKnife). Methods: 694 patients treated with CyberKnife between 2005 and 2019 were retrospectively reviewed. Age, gender, best-corrected visual acuity (BCVA), tumor height and diameter were recorded. Treatment planning and radiation doses were reviewed. Salvage therapy, overall survival, metastasis, and complications were recorded. Results: 74 patients showed local recurrence. Local recurrence occurred after 42.1 months post CyberKnife treatment (mean; range: 5 – 100 months). 14 out of 74 patients (18.9%) died during follow-up. Recurrence treatment included enucleation in 51 patients (68.9%) and radiosurgery in 19 patients (25.7%). Treatment planning without contrast medium MRI, radiation dose of less than 21 Gy and insufficient margin delineation were identified as risk factors incrementing local control. Discussion: Robotic assisted radiosurgery (CyberKnife) is a suitable treatment option for large choroidal melanoma up to 12mm. Patients with significantly better visual acuity received repeat Cyberknife treatment as salvage therapy and showed an eye retention rate of 81%.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Local Recurrence in Choroidal Melanomas following Robotic-Assisted Radiosurgery (CyberKnife)

et al. 2022

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“…We previously found local control rates for ciliary body melanomas treated with 18–22 Gy at an 70% isodose to be 85% after 3 years [30]. Interestingly, there was a significant difference between patients treated with a prescription dose of 21 Gy (local control rate 90.5%) and patients treated with prescription doses of 20 Gy or less (local control rate 71%) [30].…”

Section: Discussionmentioning

confidence: 99%

Robotic CyberKnife radiosurgery for small choroidal melanomas

Schmelter

Hofmann²,

Schneider

et al. 2022

Melanoma Research

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Plaque brachytherapy is the most common procedure for the treatment of small choroidal melanoma, especially in posteriorly located tumors. However, there is only little information on outcome after treatment with stereotactic radiosurgery, for example, CyberKnife radiosurgery. We reviewed patients with choroidal melanoma (maximum tumor height 4 mm) treated with CyberKnife radiosurgery. Demographic information, tumor dimension, complications, metastasis and overall survival during the whole follow-up were tracked and analyzed with a specific focus on local tumor control and potential risk factors. One hundred eighty-eight patients (102 female, 54.2%) with a median age of 63 years [interquartile range (IQR): 54–73 years] were analyzed over a median of 46 months (IQR: 24–62 months). Metastasis occurred in 14 patients (7.4%) in median of 18 months after treatment (IQR: 13–47 months) and survival was achieved in 178 patients (94.7%). Within the observation period, eye retention was observed in 166 patients (88.3%). Superior local control was achieved in patients who received a prescription dose of at least 21 Gy or more (91.6%; P = 0.04). Other potential risk factors incrementing local control were treatment planning with missing MRI in advance and too small target delineation during the planning process. Radiosurgery (CyberKnife) in a single, outpatient procedure is suitable for the treatment of small choroidal melanoma. We found local control rate after 3 years compared to the standard treatment with plaque brachytherapy. On the study side, 15 years of CyberKnife treatment allowed to identify risk factors that might increment local control and thus improve treatment regimens.

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“…This case series is the first to evaluate CyberKnife treatment in patients suffering from VPT. CyberKnife is a robotic‐assisted radiosurgical treatment option and is used for the treatment of different tumours such as prostate cancer or uveal melanoma (Eibl‐Lindner et al 2016; Liegl et al 2020). CyberKnife treatment can be facilitated in an outpatient setting and does not need surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Robotic‐assisted radiosurgery for the treatment of vasoproliferative tumours

Schmelter

Fuerweger

Muacevic³

et al. 2020

Acta Ophthalmologica

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Purpose Vasoproliferative tumours (VPT) are a rare but benign entity that can lead to severe visual acuity deterioration. There is no standard of care, and depending on the degree of clinical features, including tumour size and dissemination, visual acuity and subretinal fluid, treatment options include observation, cryotherapy and brachytherapy. Particularly in larger tumours, brachytherapy has advantages over other options, although higher radiation doses and the need for surgical application are disadvantages of this otherwise effective treatment option. CyberKnife radiosurgery might represent an alternative therapeutic option as no surgical intervention is needed and radiation doses are lower. Methods All patients diagnosed with vasoproliferative tumors who were treated with CyberKnife radiosurgery with a minimum follow‐up time of 12 months were included in this case series. We recorded visual acuity, number of lesions, central retinal thickness with optical coherence tomography (OCT) and reflectivity using A‐scan standardizes echography every three months. Results A total of four patients with a median age of 34 years (range: 24 – 51) who were observed over an average of 26.5 months (range: 17 – 49 months) matched our inclusion criteria. We appreciated stabilization or increase in visual acuity in all four patients and a regression in tumour thickness with subsequent increase in internal reflectivity as a marker of increasing fibrosis. Conclusion We observed good visual and functional outcome following CyberKnife therapy for VPT. We believe that further studies should be pursued to evaluate CyberKnife therapy for the treatment of VPT not treatable with cryo‐ or lasertherapy.

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Robotic CyberKnife Radiosurgery for Ciliary Body Melanoma

Cited by 5 publications

References 7 publications

Local Recurrence in Choroidal Melanomas following Robotic-Assisted Radiosurgery (CyberKnife)

Local Recurrence in Choroidal Melanomas following Robotic-Assisted Radiosurgery (CyberKnife)

Robotic CyberKnife radiosurgery for small choroidal melanomas

Robotic‐assisted radiosurgery for the treatment of vasoproliferative tumours

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