Ruthenium brachytherapy for uveal melanomas: Factors affecting the development of radiation complications

Pagliara, Monica Maria; Tagliaferri, Luca; Azario, L.; Lenkowicz, Jacopo; Lanza, Angela; Autorino, Riccardo; Caputo, Carmela Grazia; Gambacorta, M.A.; Valentini, Vincenzo; Blasi, Maria Antonietta

doi:10.1016/j.brachy.2017.11.004

Cited by 27 publications

(30 citation statements)

References 23 publications

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“…The use of interventional radiotherapy (BT) has increased in the last decades, most probably due to technical improvements, allowing to deliver higher doses to the target while reducing dose and volume of organs at risk [9]. Moreover, BT in Italy has been increasingly based on a multidisciplinary approach, with a growing number of high-quality publications of excellent treatment results [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31]. These innovations, in the context of a rapid diffusion of 3D planning, with an increased use of computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and ultrasound, favored the diffusion of image-guided brachytherapy (IGBT) [32] with related clinical benefits.…”

Section: Discussionmentioning

confidence: 99%

Current state of interventional radiotherapy (brachytherapy) education in Italy: results of the INTERACTS survey

Tagliaferri¹,

Kovács

Aristei

et al. 2019

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PurposeIncreased complexity of interventional radiotherapy (brachytherapy – BT) treatment planning and quality control procedures has led to the need of a specific training. However, the details of the features of BT learning objectives and their distribution in the training paths of the Italian Radiation Oncology Schools are not known. This paper aims to provide the actual ‘state-of-the-art’ of BT education in Italy and to stimulate the debate on this issue.Material and methodsAll the Italian radiation oncology schools’ directors (SD) were involved in a web survey, which included questions on the teaching of BT, considering also the 2011 ESTRO core curriculum criteria. The survey preliminary results were discussed at the 8th Rome INTER-MEETING (INTERventional Radiotherapy Multidisciplinary Meeting), June 24th, 2017. The present paper describes the final results of the survey and possible future teaching strategies resulting from the discussion.ResultsA total of 23 SDs answered the survey. The results evidenced a wide heterogeneity in the learning activities available to trainees in BT across the country. While theoretical knowledge is adequately and homogeneously transmitted to trainees, the types of practice to which they are exposed varies significantly among different schools.ConclusionsThis survey proves the need for an improvement of practical BT education in Italy and the advisability of a national BT education programme networking schools of different Universities. Beside the organization of national/international courses for BT practical teaching, Universities may also establish post-specialization courses (‘second level’ Masters) to allow professionals (already certified in radiation oncology) to acquire more advanced BT knowledge.

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Section: Discussionmentioning

confidence: 99%

Current state of interventional radiotherapy (brachytherapy) education in Italy: results of the INTERACTS survey

Tagliaferri¹,

Kovács

Aristei

et al. 2019

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“…No differences were reported from the latter author among the local control in the two groups. In the light of the above considerations, marginal recurrences appear to be the most adequate indications for re-treatments with plaques [30]. Supported by our experience, we suggest that clinical implementation of validated nomograms [31] based on large patient cohorts may contribute to a better patient selection [32].…”

Section: Discussionmentioning

confidence: 97%

Personalized re-treatment strategy for uveal melanoma local recurrences after interventional radiotherapy (brachytherapy): single institution experience and systematic literature review

Tagliaferri¹,

Mm²,

Fionda³

et al. 2019

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Purpose: To report the results of a patient's tailored therapeutic approach using a second course of interventional radiotherapy (brachytherapy) in patients with locally recurrent uveal melanoma. Material and methods: Patients who had already undergone ocular brachytherapy treated at our IOC (Interventional Oncology Center) were considered. Five patients who has received a second course of treatment with a plaque after local recurrences were included in our study. Re-irradiation was performed with Ruthenium-106 (prescribed dose to the apex 100 Gy) or with Iodine-125 plaques (prescribed dose to the apex 85 Gy). Moreover, a systematic literature search was conducted through three electronic databases, including Medline/PubMed, Scopus, and Embase. Results: All patients were initially treated with Ruthenium-106 plaque; the re-irradiation was performed with Ruthenium-106 plaque in three cases and with Iodine in two cases. Mean time between the first and the second plaque was 56.8 months (range, 25-93 months). Local tumor control rate was 100%, no patient underwent secondary enucleation owing to re-treatment failure. Distant metastasis occurred in 1 patient after 6 months from re-treatment. After a median follow-up of 44.2 months (range, 26-65 months) from re-treatment, all patients experienced worsening of the visual acuity (median visual acuity was 0.42 at time of recurrence and decline to 0.24 at the most recent follow-up); cataract occurred in two cases, no patient developed scleral necrosis. We considered 2 papers for a systematic review. Conclusions: In selected cases, especially in presence of marginal local recurrence, a personalized re-treatment strategy with a plaque may offer high probability of tumor control and organ preservation but worsening of visual acuity.

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“…The development of radiation complications, including CME, radiation maculopathy, papillopathy, retinopathy, NVI and NVG, following plaque radiotherapy of uveal melanoma is a common occurrence that can lead to significant vision loss 14‐16 . The use of intravitreal anti‐VEGF has been beneficial in the treatment of post‐radiation complications and could represent a potential advance in the prevention of radiation complications, allowing the improvement of anatomical and functional visual outcome 12,17‐19 …”

Section: Discussionmentioning

confidence: 99%

Impact of uveal melanoma thickness on post‐plaque radiotherapy outcomes in the prophylactic anti‐vascular endothelial growth factor era in 1131 patients

Yang

Dalvin

Mazloumi

et al. 2020

Clinical Exper Ophthalmology

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Importance The impact of tumour thickness on radiation complications following plaque radiotherapy for uveal melanoma in the anti‐vascular endothelial growth factor (VEGF) era remains unknown. Background To evaluate treatment outcomes following plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma based on initial tumour thickness. Design This was a retrospective, interventional case series. Participants Patients with uveal melanoma were included in this study. Methods A review of medical records was conducted of patients with uveal melanoma treated with plaque radiotherapy and prophylactic intravitreal bevacizumab from 7 July 2000 to 2 November 2018. Main outcomes measures Radiation‐related outcomes of cystoid macular oedema (CME), radiation maculopathy, papillopathy, retinopathy, iris neovascularization (NVI) and neovascular glaucoma (NVG) were compared based on tumour thickness (small [<3.0 mm] vs medium [3.1‐8.0 mm] vs large [>8.0 mm]). Results Of 1131 eyes, 341 (30%) had small, 633 (56%) medium and 157 (14%) large melanoma. Comparison (small vs medium vs large) at 4 years following radiotherapy revealed large melanoma with greater Kaplan‐Meier estimated risk of CME (37% vs 37% vs 63%, P < .001), earlier onset of CME (33 vs 26 vs 19 months, P < .001) and greater development of NVI (<1% vs 2% vs 13%, P < .001) and NVG (1% vs 2% vs 12%, P < .001). Radiation‐induced maculopathy, papillopathy and retinopathy were not associated with tumour thickness. Conclusions and relevance Compared with small and medium uveal melanoma, large uveal melanoma demonstrated greater 48‐month risk for CME, shorter time to CME onset and greater development of NVI and NVG following plaque radiotherapy and prophylactic intravitreal bevacizumab.

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Ruthenium brachytherapy for uveal melanomas: Factors affecting the development of radiation complications

Cited by 27 publications

References 23 publications

Current state of interventional radiotherapy (brachytherapy) education in Italy: results of the INTERACTS survey

Current state of interventional radiotherapy (brachytherapy) education in Italy: results of the INTERACTS survey

Personalized re-treatment strategy for uveal melanoma local recurrences after interventional radiotherapy (brachytherapy): single institution experience and systematic literature review

Impact of uveal melanoma thickness on post‐plaque radiotherapy outcomes in the prophylactic anti‐vascular endothelial growth factor era in 1131 patients

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