Robotic CyberKnife radiosurgery for small choroidal melanomas

Schmelter, Valerie; Hofmann, Theresa; Schneider, F; Weber, Constance; Fuerweger, Christoph; Muacevic, Alexander; Priglinger, Siegfried; Foerster, Paul; Liegl, Raffael

doi:10.1097/cmr.0000000000000823

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…Two recent studies with the longest follow-up periods have been recently published. The first study (n = 188, median follow-up = 46 months) reported metastasis in 14 patients (7.4%) 18 months after treatment (median), and survival was achieved in 178 patients (94.7%) [8]. Within the observation period, eye retention was reported in 166 68.5-84.6%) when treated with 20 Gy or less [7].…”

Section: Discussionmentioning

confidence: 99%

“…The use of modern RT techniques, such as stereotactic radiosurgery (SRS) or proton beam RT, promises better preservation of organs at risk. For instance, SRS and proton beam therapy have been described as effective treatments for larger choroidal melanomas [7‒9]. Here, we report on 4 patients diagnosed with medium-choroidal UM treated with CyberKnife SRS in a single session.…”

Section: Introductionmentioning

confidence: 99%

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CyberKnife Stereotactic Radiosurgery for Uveal Melanoma: First Case Series in Central America

Benavides,

Mejías,

Blanco

et al. 2023

Ocul Oncol Pathol

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Introduction: Uveal melanoma is the most common primary intraocular malignancy in adults, affecting primarily the choroid of the eye. Plaque brachytherapy is the most common procedure for the treatment of small choroidal melanoma, especially in posteriorly located tumors. However, modern radiotherapy techniques, such as CyberKnife or Gamma knife stereotactic radiosurgery (SRS) and proton beam radiotherapy, have shown better results in tumor control and eye retention. Recent studies have indicated that SRS is a promising non-invasive, single-session treatment option, with most studies reporting the best outcomes when using ≥21–22 Gy. However, there is no consistent protocol for managing this pathology using CyberKnife, not only in terms of dose but also fractions. Case Presentations: Here, we report the first case series of patients (n = 4, age range 38–64 years, median age 52.5 years) with choroidal UM in Central America who were treated with CyberKnife SRS (22 Gy in one session). During the follow-up (range 25–29 months, median 27.5 months), a 100% control rate with no systemic metastatic disease has been achieved. We found a statistically significant reduction in the largest basal diameter at 24 months for all tumors. However, visual acuity has progressively decreased in most patients. Notably, two of our patients developed radiation maculopathy, and the other two developed radiation retinopathy after SRS. Conclusions: Our findings suggest that future studies should evaluate the use of different prophylactic therapies to prevent the development of side effects. The clinical management of toxicities presented in our report can serve as a reference in the clinical practice of other centers. Our report supports the growing body of evidence showing that CyberKnife radiosurgery is a safe and effective therapeutic option for the treatment of UM.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CyberKnife Stereotactic Radiosurgery for Uveal Melanoma: First Case Series in Central America

Benavides,

Mejías,

Blanco

et al. 2023

Ocul Oncol Pathol

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“…Conventionally, MRI has had a limited role in ocular radiotherapy [139,140]. A notable exception has been stereotactic radiosurgery, where MRI is reportedly being used to complement CT imaging [141][142][143][144][145][146][147] and has shown to contribute to an increase in local control [148]. However, for other forms of ocular radiotherapy, such as brachytherapy and proton beam therapy, the therapy is planned using a dome-shaped model to approximate the tumour geometry.…”

Section: Therapy Planningmentioning

confidence: 99%

Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients—A Systematic Review from an Ophthalmic Perspective

Jaarsma-Coes

Klaassen

Marinković

et al. 2023

Cancers

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Conversely to most tumour types, magnetic resonance imaging (MRI) was rarely used for eye tumours. As recent technical advances have increased ocular MRI’s diagnostic value, various clinical applications have been proposed. This systematic review provides an overview of the current status of MRI in the clinical care of uveal melanoma (UM) patients, the most common eye tumour in adults. In total, 158 articles were included. Two- and three-dimensional anatomical scans and functional scans, which assess the tumour micro-biology, can be obtained in routine clinical setting. The radiological characteristics of the most common intra-ocular masses have been described extensively, enabling MRI to contribute to diagnoses. Additionally, MRI’s ability to non-invasively probe the tissue’s biological properties enables early detection of therapy response and potentially differentiates between high- and low-risk UM. MRI-based tumour dimensions are generally in agreement with conventional ultrasound (median absolute difference 0.5 mm), but MRI is considered more accurate in a subgroup of anteriorly located tumours. Although multiple studies propose that MRI’s 3D tumour visualisation can improve therapy planning, an evaluation of its clinical benefit is lacking. In conclusion, MRI is a complementary imaging modality for UM of which the clinical benefit has been shown by multiple studies.

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Measurements regarding a combined therapy concept for ophthalmic tumors consisting of brachytherapy and x-rays

Manke,

Fluehs,

Stroth

et al. 2024

Biomed. Phys. Eng. Express

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ObjectiveWe present a novel concept to treat ophthalmic tumors which combines brachytherapy and low-energy x-ray therapy. Brachytherapy with 106Ru applicators applicators is inadequate for intraocular tumors with a height of 7 mm and more. This results from a steep dose gradient, and it is unfeasible to deliver the required dose at the tumor apex without exceeding the maximum tolerable sclera dose of usually 1000 to 1500 Gy. Other modalities, such as irradiation with charged particles, may be individually contraindicated. A dose boost at the apex provided by an x-ray therapy unit, performed simultaneously with the brachytherapy, results in a more homogeneous dose profile than brachytherapy alone. This avoids damage to organs at risk. The applicator may also serve as a beam stop for x-rays passing through the target volume, which reduces healthy tissue dosage. This study aims to investigate the suitability of the applicator to serve as a beam stop for the x-rays. ApproachA phantom with three detector types comprising a soft x-ray ionization chamber, radiochromic films, and a self-made scintillation detector was constructed to perform dosimetry. Measurements were performed using a conventional x-ray unit for superficial therapy to investigate the uncertainties of the phantom and the ability of the applicator to absorb x-rays. The manufacturer provided a dummy plaque to obtain x-ray dose profiles without noise from 106Ru decays.ResultsThe phantom is generally feasible to obtain dose profiles with three different detector types. The interaction of x-rays with the silver of the applicator leads to an increased dose rate in front of the applicator. The dose rate of the x-rays is reduced by up to 90 % behind a 106Ru applicator. Therefore, a 106Ru applicator can be used as a beam stop in combined x-ray and brachytherapy treatment.

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Robotic CyberKnife radiosurgery for small choroidal melanomas

Cited by 3 publications

References 33 publications

CyberKnife Stereotactic Radiosurgery for Uveal Melanoma: First Case Series in Central America

CyberKnife Stereotactic Radiosurgery for Uveal Melanoma: First Case Series in Central America

Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients—A Systematic Review from an Ophthalmic Perspective

Measurements regarding a combined therapy concept for ophthalmic tumors consisting of brachytherapy and x-rays

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