Stereotactic Rediosurgery for Uveal Melanoma; Postradiation Complications
Authors:
A. Furdová 1; M. Šramka 2; I. Waczulíková 3; M. Chorvath 2; O. Trompak 2; I. Krčová 1; K. Horkovičová 1
Authors place of work:
Klinika oftalmológie Lekárskej fakulty Univerzity Komenského a Univerzitná nemocnica, Nemocnica Ružinov, Bratislava, prednosta doc. MUDr. Vladimír Krásnik, PhD.
1; Klinika stereotaktickej rádiochirurgie OÚSA a VŠZaSP, Bratislava, prednosta prof. MUDr. Miron Šramka, DrSc.
2; Katedra jadrovej fyziky a biofyziky, Oddelenie biomedicínskej fyziky, Fakulta matematiky, fyziky a informatiky Univerzity Komenského, Bratislava, vedúci doc. RNDr. Stanislav Tokár, CSc.
3
Published in the journal:
Čes. a slov. Oftal., 71, 2015, No. 3, p. 134-142
Category:
Original Article
Časť práce bola prednesená na XXII. Výročnom zjazde Českej oftalmologickej spoločnosti v Prahe, jún 2014.
Summary
Objective:
The authors evaluate a group of patients with malignant uveal melanoma treated with stereotactic radiosurgery in the year. 2009–2011 on a linear accelerator LINAC.
Material and methods:
In 2009–2011 were followed 40 patients with malignant melanoma of the uvea in stage T2 and T3 treated with stereotactic radiosurgery (LINAC), the therapeutic dose of 35,0 Gy TD, TD max 42,0 Gy. We evaluated the influence of factors (age, exposure risk structures, time) to intraocular pressure (IOP) and temporal changes in intraocular pressure after surgery between the control group and the group of patients who underwent enucleation.
The normality of data distribution was tested Shapiro-Wilk W test and graphically. The relations between the parameters were tested using simple and multiple linear regression (correlation coefficient r, the significance level p).
Results:
The mean age of the group of 40 patients with malignant melanoma of the uvea treated by one day session stereotactic radiosurgery on a linear accelerator in the year. 2009–2011 was 55.13 ± 11.11 years. Average maximum radiation dose to sensitive structures has been the target of 12,0 Gy to the optic nerve and the ciliary 10,0 Gy.
The analysis in our group confirmed that the prevalence of the tumor independent of sex, increasing with age, with most patients are diagnosed between 60 and 70 years of age.
Analysis of the difference in intraocular pressure (IOP) before surgery showed no significant difference between the group of men and women (p = 0.54). Using simple linear regression, we confirmed assumptions, related to IOP before stereotactic radiosurgery with age (r = -0.09, p = 0.65). Multiple linear regression, we evaluated the relationship between predictors (dose at-risk structures – lens and optic nerve) and the change in IOP from the value before stereotactic radiosurgery at each time interval. Relations between predictors (Dose aperture – L, the dose of the optic nerve – O) and IOP of the file being described partial correlation coefficients after 2 weeks. For the relationship is significant correlation between the dose and the IOP in the lens at the time of 1 year, 1.5 years, and 2 years after the stereotactic radiosurgery.
Conclusion:
A single stereotactic radiosurgery on a linear accelerator LINAC is possible at a dose of 35,0 to 38,0 Gy in intraocular melanomas in stage T1 to T3. According to our results, this is a highly effective method of treatment of uveal melanomas elevation to 6 mm and a capacity of up to 0,4 cm3. Secondary glaucoma is one of the most serious causes of enucleation after one day session stereotactic radiosurgery at linear accelerator (LINAC) for uveal melanoma. The percentage of enucleation in our investigated group (17.5%) for secondary glaucoma is about the same as in other studies.
Key words:
intraocular tumors, malignant melanoma of the uvea, stereotactic radiosurgery, linear accelerator
Zdroje
1. Augsburger, J.J., Schneider, S., Freire, J., et al.: Survival following enucleation versus plaque radiotherapy in statistically matched subgroups of patients with choroidal melanomas: results in patients treated between 1980 and 1987. Graefes Arch Clin Exp Ophthalmol, 237; 1999: 558–567.
2. Bornfeld, N., Talies, S., Anastassiou, G., et al.: Endoresection maligner Melanome der Uvea nach praoperativer stereotaktischer Einzeldosis-Konvergenzbestrahlung mit dem Leksell-Gamma-knife. Ophthalmologe, 99; 2002: 338–344.
3. Cohen, V.M.L., Carter, M.J., Kemeny, A., et al.: Metastasis-free survival following treatment for uveal melanoma with either stereotactic radiosurgery or enucleation. Acta Ophthalmol Scand, 81; 2003: 383–388.
4. Damato, B.E., Lecuona, K.: Conservation of eyes with choroidal melanoma by a multimodality approach to treatment. An audit of 1632 patients. Ophthalmology, 111; 2004: 977–983.
5. Damato, B.E., Paul, J., Foulds, W.S.: Risk factors for metastatic uveal melanoma after transscleral local resection. Br J Ophthal, 8; 1996: 109–116.
6. Damato, B.E., Paul, J., Foulds, W.S.: Risk factors for residual and recurrent uveal melanoma after transscleral local resection. Br J Ophthal, 80; 1996: 102–108.
7. Diaz, C.E., Capone, Jr. A., Grossinklaus, H.E.: Clinicopathologic Findings in Recurrent Choroidal Melanoma after Transpupillary Thermotherapy. Ophthalmology, 105(8); 1998: 1419–1424.
8. Dieckmann, K., Georg, D., Zehetmayer, M., et al.: LINAC based stereotactic radiotherapy of uveal melanoma: 4 years clinical experience. Radiother Oncol, 67; 2003: 199–206.
9. Egger, E., Zografos, L., Schalenbourg, A., et al.: Eye retention after proton beam radiotherapy for uveal melanoma. Int J Radiat Oncol Biol Phys, 55; 2003: 867–880.
10. Finger, P.T.: Radiation Therapy for Choroidal Melanoma. Survey of Ophthalmology, 42; 1997: 215–232.
11. Foss, A.J., Whelehan, I., Hungerford, J.L., et al.: Predictive factors for the development of rubeosis following proton beam radiotherapy for uveal melanoma. Br J Ophthalmol, 91; 1997: 748–754.
12. Furdová, A., Chorváth, M., Waczulíková, I., et al.: No differences in outcome between radical surgical treatment (enucleation) and stereotactic radiosurgery in patients with posterior uveal melanoma. Neoplasma, 57(4); 2010: 377–381.
13. Furdová, A., Oláh, Z.: Malígny melanóm v uveálnom trakte. Bratislava, Asklepios. 2002, 172 s.
14. Furdová, A., Oláh, Z.: Nádory oka a okolitých štruktúr. Brno, CERM. 2010, 152 s.
15. Furdova, A., Strmen, P., Sramka, M.: Complications in patients with uveal melanoma after stereotactic radiosurgery and brachytherapy. Bratislava Medical Journal – BLL, 106(12); 2005: 401–406.
16. Furdova, A., Strmen, P., Waczulikova, I., et al.: One-day session LINAC-based stereotactic radiosurgery of posterior uveal melanoma. Eur J Ophthalmol, 22(2); 2012: 226–235.
17. Furdová, A., Šramka, M.: Uveal malignant melanoma and stereotactic radiosurgery. Saarbrücken: LAP LAMBERT Academic Publishing. 2014, 181 s.
18. Ghazi, N.G., Ketscheride, C.S., Sheehan, J., et al.: Gamma knife radiosurgery for uveal melanoma ineligible for brachytherapy by the Collaborative Ocular Melanoma Study criteria. Open Access Surgery, 1; 2008: 21–24.
19. Gragoudas, E.S.: Proton beam therapy: proton therapy for uveal melanoma – 20 years experience. 2001 Subspeciality Day, Retina, 2001, American Academy of Ophthalmology, New Orleans, Lousiana, 10; 2001.
20. Gragoudas, E.S., Lane, A.M., Munzenrider, J., et al.: Long-term risk of local failure after proton therapy for choroidal/ciliary body melanoma. Trans Am Ophthalmol Soc, 100; 2002: 43–48.
21. Jaywant, S.M., Osei, E.K., Ladak, S.: Stereotactic radiotherapy in treatment of ocular melanoma: A noninvasive eye fixation aid and tracking system. Am Coll Med Phys, 4; 2003: 156–161.
22. Krause, L., Bechrakis, N., Heinrich, S., et al.: Indocyanine green angiography and fluorescein angiography of malignant choroidal melanomas following proton beam irradiation. Graefe´s Archive for Clinical and Experimental Ophthalmology, 246(6); 2004: 545–550.
23. Krema, H., Somani, S., Sahgal, A., et al.: Stereotactic radiotherapy for treatment of juxtapapillary choroidal melanoma: 3-year follow-up. Br J Ophthalmol, 93; 2009: 1172–1176.
24. Lommatzsch, P.K.: Intraoculare Tumoren. Leitfaden für Diagnostik und Therapie. Enke Verlag, Stuttgart, 1989, 161 p.
25. Lučenič, A., Fríbertová, M., Chorváth, M.: Stereotaktická rádiochirurgia malígneho melanómu oka. Onkológia, 6; 2011: 35.
26. Manschot, W.A., van Strik, R.: Is irradiation a justifable treatment of choroidal melanoma? Analysis of published results. Br J Ophthal, 71; 1987: 348–352.
27. Midena, E., Segato, T., Valenti, M., et al.: The Effect of external Eye Irradiation on Choroidal Circulation. Ophthalmology, 103; 1996: 1651–1660.
28. Mueller, A.J., Schaller, U., Talies, S., et al.: Stereotaktische Konvergenz-bestrahlung grosser uvealer Melanome mit dem Gamma-knife. Ophthalmologe, 100; 2003: 122–128.
29. Oliver, S., Leu, M., Demarco, J., et al.: Attenuation of iodine 125 radiation with vitreous substitutes in the treatment of uveal melanoma. Arch Ophthalmol, 128(7); 2010: 888–893.
30. Pochop, P., Pilbauer, J., Křepelková, J., et al.: Dva roky zkušeností s léčbou Leksellovým gama nožem. Čes a slov Oftalmol, 54(4); 1998: 222–234.
31. Seregard, S., Kock, E.: Prognostic indicators following enucleation for posterior uveal melanoma. A multivariate analysis of longterm survival with minimized loss to follow-up. Acta Ophthalmol Scand, 73; 1995: 340–344.
32. Shields, C.L., Shields, J.A., et al.: Prevalence and Mechanisms of Secondary Intraocular Pressure Elevation in Eyes with Intraocular Tumors. Ophthalmology, 94; 1987: 839–846.
33. Shields, J.A.: Advances in management of intraocular tumors. Highlights of Ophthalmology, 22; 1994: 32–34.
34. Shields, J.A., Shields, C.L.: Current alternatives in the management of posterior uveal melanomas. Trans. Am. Acad. Ophthalmol. Otolaringol., 42; 1990: 938–944.
35. Shields, J.A., Shields, C.L., Davidson, R., et al.: Iris Melanoma Arising From sector Congenital Ocular Melanocytosis in a Child. Cornea, 28(10); 2009: 1191-1193.
36. Šramka, M.: Stereotaktická rádiochirurgia v liečbe nádorov hlavy a krku. Onkológia 2; 2006: 126–129.
37. Tokuuye, K., Akine, Y., Sumi, M., et al.: Fractionated stereotactic radiotherapy for choroidal melanomas. Radiother Oncol, 42; 1997: 87–91.
38. Zehetmeyer, M., Kitz, K., Menapace, R., et al.: Local tumor control and morbidity after one to three fractions of stereotactic external beam irradiation for uveal melanoma. Radiother Oncol, 55; 2000: 135–144.
39. Zytkovicz, A., Daftari, I., Phillips, T.L., et al.: Peripheral dose in ocular treatment with Cyberknife and Gamma Knife radiosurgery compared to proton radiotherapy. Phys Med Biol, 52; 2007: 5957–5971.
Štítky
OphthalmologyČlánok vyšiel v časopise
Czech and Slovak Ophthalmology
2015 Číslo 3
Najčítanejšie v tomto čísle
- Functional Magnetic Resonance Imaging in Selected Eye Diseases
- Intrinsically Photosensitive Retinal Ganglion Cells
- Surgical Treatment of the Idiopathic Macular Hole by Means of 25-Gauge Pars Plana Vitrectomy with the Peeling of the Internal Limiting Membrane Assisted by Brilliant Blue and Gas Tamponade
- Malignant Choroidal Melanoma in T4 Orbital Stage; Prosthesis of the Orbit