Treatment of Uveal Melanoma With Radioactive Iodine 125 Implant Compared With Proton Beam Radiotherapy

Background: Currently, radiotherapy represents the most widely employed therapeutic option in patients with uveal melanoma. Although the effects of proton beam radiotherapy on uveal melanoma end ocular tissues have been histologically documented, their appearance at MR imaging is still poorly understood. The purpose of our study was to elucidate the magnetic resonance (MR) semiotics of radiotherapy-induced changes to neoplastic tissues and ocular structures in patients with uveal melanoma undergoing secondary enucleation after proton beam radiotherapy. Methods: Nine patients with uveal melanoma who had undergone proton beam radiotherapy, MR imaging, and subsequent secondary enucleation were retrospectively selected. The histopathologic findings evaluated for irradiated tumors were necrosis, fibrosis, and viable tumor, while the histopathologic findings evaluated for extratumoral ocular/periocular tissues were radiation-related intraocular inflammation, vitreous hemorrhage, optic nerve degeneration, iris neovascularization, and periocular fibrotic adhesions. On MR images, the appearance of the abovementioned histologic features was assessed on conventional and diffusion-weighted sequences. Results: T2-weighted sequences performed better in detecting radiation-induced necrosis, fibrosis, optic nerve degeneration, and periocular fibrotic adhesions. T1-weighted sequences were preferable for identifying cataracts, vitreous hemorrhage, and inflammatory complications. Contrast-enhanced T1-weighted sequences were irreplaceable in assessing iris neovascularization, and in confirming inflammatory complications. Conclusions: In the light of their increasing role in the multidisciplinary management of patients with uveal melanoma, radiologists should be aware of the MR appearance of the effects of radiotherapy on neoplastic and ocular tissue, in order to improve the accuracy of follow-up MR examinations.

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Proton beam radiotherapy for uveal melanoma

Expert Review of Ophthalmology ◽

10.1586/17469899.2015.1120671 ◽

2015 ◽

Vol 10 (6) ◽

pp. 577-585

Author(s):

Armin R Afshar ◽

Jay M Stewart ◽

Andrew A Kao ◽

Kavita K Mishra ◽

Inder K Daftari ◽

...

Keyword(s):

Proton Beam ◽

Uveal Melanoma ◽

Proton Beam Radiotherapy

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OCT changes in peri-tumour normal retina following ruthenium-106 and proton beam radiotherapy for uveal melanoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314802 ◽

2020 ◽

pp. bjophthalmol-2019-314802

Author(s):

Rumana Hussain ◽

Florian Moritz Heussen ◽

Heinrich Heimann

Keyword(s):

Proton Beam ◽

Uveal Melanoma ◽

Choroidal Melanoma ◽

Retinal Layer ◽

Proton Beam Radiotherapy ◽

Retinal Layers ◽

Spectral Domain Oct ◽

Ruthenium 106 Brachytherapy ◽

Safety Margins ◽

Plaque Brachytherapy

IntroductionUveal melanoma is most commonly treated with radiotherapy, destroying the tumour cells with adequate safety margins and limiting collateral damage to surrounding structures to preserve maximal vision. We used optical coherence tomography (OCT) to study the effects of radiotherapy on the retina.MethodsPatients with posteriorly located choroidal melanoma treated with proton beam radiotherapy (PBR) and ruthenium-106 brachytherapy between January 2010 and June 2014 underwent spectral domain OCT.ResultsImages of 32 patients following ruthenium-106 brachytherapy and 44 patients following proton beam teletherapy were analysed. Following plaque brachytherapy, an early marked disruption of the outer retinal layers could be observed in 30 cases (94%) with retinal atrophy evident in 26 cases (81%). In contrast, the images from patients who underwent PBR showed subtle outer retinal layer change with 16 cases (36%) showing some inner-outer segment junction disruption by 6 months and 63% by 24 months with minimal atrophy. In cases with tumours <2 mm from the fovea, the visual loss was significantly less at 6 and 12 months in the proton beam group.ConclusionIn comparison to ruthenium-106 plaque brachytherapy, PBR leads to more subtle and slower changes in the outer retinal layers enabling retention of visual function for longer. The difference in dosing regime and dose distribution across the tumour is likely to be causative for this structural differential.

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Proton beam radiotherapy in the management of uveal melanoma: Clinical experience in Scotland

Clinical Ophthalmology ◽

10.2147/opth.s3555 ◽

2008 ◽

pp. 49 ◽

Cited By ~ 1

Author(s):

Samir Aziz

Keyword(s):

Proton Beam ◽

Uveal Melanoma ◽

Clinical Experience ◽

Proton Beam Radiotherapy

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Proton beam radiotherapy for uveal melanoma: Results of Curie Institut–Orsay Proton Therapy Center (ICPO)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2006.01.020 ◽

2006 ◽

Vol 65 (3) ◽

pp. 780-787 ◽

Cited By ~ 142

Author(s):

Rémi Dendale ◽

Livia Lumbroso-Le Rouic ◽

Georges Noel ◽

Loïc Feuvret ◽

Christine Levy ◽

...

Keyword(s):

Proton Beam ◽

Uveal Melanoma ◽

Proton Therapy ◽

Proton Beam Radiotherapy ◽

Therapy Center

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Long-Term Visual Outcomes for Small Uveal Melanoma Staged T1 Treated by Proton Beam Radiotherapy

Cancers ◽

10.3390/cancers11081047 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1047 ◽

Cited By ~ 2

Author(s):

Adélaïde Toutée ◽

Martina Angi ◽

Sylvain Dureau ◽

Christine Lévy-Gabriel ◽

Livia Lumbroso-Le Rouic ◽

...

Keyword(s):

Proton Beam ◽

Optic Disc ◽

Uveal Melanoma ◽

Early Stage ◽

Tumor Control ◽

Proton Beam Radiotherapy ◽

Visual Outcomes ◽

The Mean

There is increasing evidence of the survival benefit of treating uveal melanoma in an early stage, however it is important to discuss with the patient the associated risk of visual loss. We investigated visual outcomes for uveal melanomas staged T1 (T1UM) treated by proton beam radiotherapy (PBR) as a function of their distance to fovea-optic disc. This retrospective study included a cohort of 424 patients with T1UM treated with PBR between 1991 and 2010 with at least a 5-year follow-up. Visual acuity (VA) was analyzed for patients with posterior edge of tumor located at ≥3 mm (GSup3) or <3 mm (GInf3) from fovea-optic disc. The mean follow-up duration was 122 months, no tumor recurrence was observed. The mean baseline and final VA were 20/25 and 20/32 for GSup3 (n = 75), and 20/40 and 20/80 for GInf3 (n = 317) respectively. The frequency of a 20/200 or greater visual conservation was 93.2%(CI95%:87.7–99.1) and 60.1%(CI95%:54.9–65.9) for GSup3 and GInf3 respectively. This difference between groups was statistically significant (p < 0.001). The risk factors for significant VA loss (less than 20/200) were GInf3 location (p < 0.001), tumor touching optic disc (p = 0.04), initial VA inferior to 20/40 (p < 0.001), documented growth (p = 0.002), and age greater than 60 years (p < 0.001). In summary, PBR for T1UM yields excellent tumor control and good long-term visual outcomes for tumors located ≥3 mm from fovea-optic disc.

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