Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in Small Uveal Melanoma

Purpose: This work evaluates a microincisional vitrectomy surgical (MIVS) approach to endolaser ablation of small uveal malignant melanoma by incorporating genetic tumor classification as a means to avoid radiotherapy while maintaining local tumor control without compromising visual acuity (VA). Methods: An institutional review board–approved, single-surgeon, retrospective analysis was conducted of a consecutive case series of all patients with tumors less than 2.5 mm in apical thickness who underwent MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide for small uveal melanoma between 2012 and 2015. Results: A total of 226 patients underwent FNAB from January 2012 to January 2015 for uveal melanoma. All 58 patients treated for a small uveal melanoma were included. This group of patients had a minimum follow-up of 60 months (range, 60-93 months). At initial diagnosis, subretinal fluid was present in 52 eyes (89.1%), macular edema was present in 24 eyes (41.4%), and epiretinal membrane was present in 11 eyes (20.1%). Fifty-six specimens (96.5%) received a molecular classification of either class 2 (4 of 56, 7.1%) or class 1 (52 of 56, 92.8%). Initial VA was 20/40 or better in 26 eyes (44.8%), and final VA was 20/40 or better in 48 of 58 eyes (82.8%). Conclusions: Endolaser tumor ablation delivered at MIVS surgery enables excellent tumor control (98.3%) and improves VA to better than 20/40 in more than 80% of treated eyes. FNAB achieves molecular classification in 96.5% of all patients undergoing treatment for small choroidal melanoma independent of tumor size.

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Fine-Needle Aspiration Biopsy for Molecular Genomic Classification: Evaluation of Transscleral vs Transvitreal Biopsy

Journal of VitreoRetinal Diseases ◽

10.1177/2474126418782069 ◽

2018 ◽

Vol 2 (4) ◽

pp. 208-212 ◽

Cited By ~ 1

Author(s):

Victor M. Villegas ◽

Aaron Gold ◽

Timothy G. Murray

Keyword(s):

Uveal Melanoma ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Case Series ◽

Molecular Classification ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Multiple Gene ◽

Fine Needle ◽

Needle Aspiration Biopsy

Purpose: To evaluate the transvitreal and transscleral fine-needle aspiration biopsy (FNAB) approach for molecular classification with gene-expression profiling (GEP) of uveal melanoma. Methods: Institutional review board–approved single-surgeon retrospective analysis of a consecutive case series of all patients undergoing FNAB using a 25-gauge-needle multipass approach for GEP analysis of uveal melanoma between 2012 and 2016. All FNAB specimens were processed for uveal melanoma diagnostic testing using a standard processing approach, and all testing was completed at a single laboratory (Castle Biosciences, Inc.). Results: Three hundred fifty-three eyes (353 patients) were included. Transvitreal biopsies were performed in 216 eyes (216/353, 61.2%), whereas transscleral biopsies were performed in 137 eyes (137/353, 38.8%). Twenty biopsies exhibited multiple gene failure (20/353, 5.6%). Excessive fluid biopsy volume was the primary association with reported multiple gene failure, occurring in 10 of 20 eyes (50%). FNAB performed via the transvitreal approach was significantly more likely to have an excessive volume report compared with transscleral biopsy (18/216, 8.3% vs 1/137, 0.7%; P < .001). Conclusions: FNAB performed via a transscleral or transvitreal multipass approach utilizing a 25-gauge needle achieves molecular classification in 95% of all patients undergoing treatment for presumed uveal melanoma independent of tumor size. Complications related to FNAB using these techniques are rare and may be associated with the presentation of the uveal melanoma.

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Small Choroidal Melanoma: Correlation of Growth Rate with Pathology

Ocular Oncology and Pathology ◽

10.1159/000517203 ◽

2021 ◽

pp. 1-10

Author(s):

Vishal Raval ◽

Shiming Luo ◽

Emily C. Zabor ◽

Arun D. Singh

Keyword(s):

Growth Rate ◽

Retinal Pigment ◽

Choroidal Melanoma ◽

Case Series ◽

Subretinal Fluid ◽

Categorical Variables ◽

Continuous Variables ◽

Basal Diameter ◽

Orange Pigment ◽

Rpe Atrophy

Purpose: The aim of the study was to evaluate equivalence of growth rate and pathologic confirmation in small choroidal melanoma (SCM). Design: This study is a case series. Subjects, Participants, and Controls: A total of 61 patients with a choroidal melanocytic tumor of size 5.0–16.0 mm in the largest basal diameter and 1.0–2.5 mm in thickness were classified into the pathology-confirmed group (n = 19), growth-confirmed group (n = 30), and with combined observations (n = 12). Methods: Distribution of clinical variables (age, gender, laterality, tumor dimensions, tumor location, and presence of orange pigment, subretinal fluid, drusen, and retinal pigment epithelial [RPE] atrophy) between the groups was analyzed. Patient and disease characteristics were summarized as the median and interquartile range for continuous variables and the frequency and percentage for categorical variables. Comparisons were made using the Wilcoxon rank sum test for continuous variables and either Fisher’s exact test or the χ2 test for categorical variables with a p value threshold of 0.05 for statistical significance. Growth rate (change in basal dimension/12 months) diagnostic of SCM was quantified. Main Outcome Measures: The primary aim of this study was to test the hypothesis that “growth” was diagnostic of SCM with the secondary aim of quantifying the malignant “growth rate” (growth rate of SCM). Results: The clinical characteristics among all 3 groups were similar except more patients with symptoms (68 vs. 20 vs. 42%, p = 0.004) and juxtapapillary location (p = 0.03) were in the pathology group than in the growth-confirmed group. Those in the combined and growth-confirmed groups had more patients with drusen (11 vs. 60 vs. 50%, p = 0.003) and RPE atrophy (11 vs. 23 vs. 67%, p = 0.003), respectively, than in the pathology group. The median time to detect growth was 9 months (range 3–26 months). The mean growth rate in basal dimension was 1.8 mm/12 months (range, 0.0–7.4 mm; [95% CI: 1.32–2.28]). Conclusions and Relevance: Choroidal melanocytic lesions exhibiting a defined growth rate can be clinically diagnosed as SCM without a need for biopsy.

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Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

Ocular Oncology and Pathology ◽

10.1159/000512030 ◽

2021 ◽

pp. 1-9

Author(s):

Biljana Kuzmanović Elabjer ◽

Mladen Bušić ◽

Andrej Pleše ◽

Mirjana Bjeloš ◽

Daliborka Miletić ◽

...

Keyword(s):

Uveal Melanoma ◽

Tumor Regression ◽

Corneal Thickness ◽

Case Series ◽

Ultrasound Biomicroscopy ◽

Close Monitoring ◽

Single Institution ◽

Retrospective Case ◽

Caucasian Patients

Introduction: Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). Objective: Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. Methods: This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (D) and the largest basal dimension (B) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial D and B values. Results: The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). D ranged from 1.82 to 5.5 mm (median 2.99 mm) and B from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for D was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for B it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. Conclusion: The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

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Optical Coherence Tomography: An Adjunctive Tool for Differentiating between Choroidal Melanoma and Metastasis

Journal of Ophthalmology ◽

10.1155/2016/9803547 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Vicktoria Vishnevskia-Dai ◽

Dinah Zur ◽

Shiran Yaacobi ◽

Iris Moroz ◽

Hadas Newman ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Retinal Thickness ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Choroidal Melanoma ◽

Case Series ◽

Subretinal Fluid ◽

Optical Coherence ◽

Choroidal Melanomas ◽

Anterior Choroidal

Purpose.To investigate the value of optical coherence tomography (OCT) for differentiation between choroidal melanoma and metastasis based on characteristics of the anterior choroidal surface and the chorioretinal interface.Methods.This retrospective observational case series included 29 patients with untreated choroidal melanomas and 21 patients with untreated choroidal metastases. Regularity and lobularity characteristics of the anterior choroidal surface were evaluated in a masked manner. Retinal and retinal pigment epithelium (RPE) findings were documented as well.Results.OCT demonstrated a regular and smooth anterior choroidal surface in 89.7% of the eyes with melanoma and in 47.6% of the eyes with metastasis (p=0.002; sensitivity = 89.7%; specificity = 52.4%). The anterior choroidal contour was lobulated in 81.0% of the eyes with metastasis versus 17.2% of the eyes with melanoma (p<0.001; sensitivity = 82.8%; specificity = 81.0%). RPE thickness and neuroretinal characteristics (e.g., retinal thickness, the presence of cysts, and the presence of subretinal fluid) were similar in both choroidal tumors.Conclusion. OCT may serve as a noninvasive adjunctive tool for the differential diagnosis of choroidal tumors. Choroidal melanomas usually demonstrate regular surfaces on OCT, while choroidal metastases usually have an irregular and lobulated surface.

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Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review

Neuro-Oncology Practice ◽

10.1093/nop/npx002 ◽

2017 ◽

Vol 4 (4) ◽

pp. 255-262

Author(s):

Ryan Rhome ◽

Isabelle M Germano ◽

Ren-Dih Sheu ◽

Sheryl Green

Keyword(s):

Systematic Review ◽

Literature Review ◽

Case Series ◽

Tumor Control ◽

Pituitary Neoplasms ◽

Review Of The Literature ◽

Biochemical Control ◽

Low Incidence

Abstract Background Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT. Methods We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly. Results With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes. Conclusions Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.

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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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Ultra-wide-field imaging of choroidal melanoma before and after proton beam radiation therapy

European Journal of Ophthalmology ◽

10.1177/1120672119873210 ◽

2019 ◽

Vol 30 (6) ◽

pp. 1397-1402

Author(s):

Angeliki Psomiadi ◽

Gertrud Haas ◽

Michael Edlinger ◽

Nikolaos E Bechrakis ◽

Georgios Blatsios

Keyword(s):

Proton Beam ◽

Choroidal Melanoma ◽

Subretinal Fluid ◽

Scanning Laser ◽

Wide Field ◽

Scanning Laser Ophthalmoscopy ◽

Proton Beam Radiotherapy ◽

Imaging Characteristics ◽

Before And After

Objective: To evaluate the imaging characteristics of choroidal melanoma before and after proton beam radiotherapy via Optos® ultra-wide-field scanning laser ophthalmoscopy. Methods: Retrospective, descriptive study of choroidal melanoma patients treated with proton beam radiotherapy. All patients underwent full clinical evaluation, including best-corrected visual acuity, ultrasound examination and ultra-wide-field scanning laser ophthalmoscopy imaging in the pseudo-colour (red and green channel) as well as auto-fluorescence mode. Tumours were classified and evaluated according to their location, size, presence of subretinal fluid, drusen, orange pigment and reflectance intensity in ultra-wide-field scanning laser ophthalmoscopy. Tumour sonographic (basal diameter, height) and ultra-wide-field scanning laser ophthalmoscopy imaging dimensions (maximal diameter) were documented. Results: A total of 39 eyes (38 patients) were followed for 24 months (range 6–48 months). Mean best-corrected visual acuity dropped from 20/40 to 20/63 after proton beam radiotherapy. There was no change in the imaging tumour characteristics during follow-up. Subretinal fluid changes were better detected in the autofluorescence compared to pseudo-colour mode. Mean tumour diameter did not significantly change in the ultra-wide-field scanning laser ophthalmoscopy although it did so in the ultrasound. No patient showed local tumour recurrence. Conclusion: The ultra-wide-field scanning laser ophthalmoscopy imaging characteristics of choroidal melanoma in the Optos® system do not significantly change after proton beam radiotherapy after a mean follow-up of 2 years.

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Clinical Findings and Genetic Expression Profiling of Three Pigmented Lesions of the Optic Nerve

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/590659 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Manuel A. de Alba ◽

Victor M. Villegas ◽

Aaron S. Gold ◽

Andrea Wildner ◽

Fiona J. Ehlies ◽

...

Keyword(s):

Expression Profiling ◽

Case Series ◽

Needle Aspiration ◽

Clinical Findings ◽

Optic Disk ◽

Posterior Chamber ◽

Diagnostic Challenge ◽

Intravitreal Triamcinolone ◽

Genetic Expression ◽

Pigmented Lesions

Background. Optic disk melanocytoma is a primary tumor of the optic disk that represents a clinical diagnostic challenge due to its similarities with melanoma.Purpose. The authors present three cases in which genetic expression profiling was used to identify tumor prognosis of optic disk melanocytoma.Case Series. In two cases fine-needle aspiration biopsy was performed to obtain tissue through a transvitreal route into the apex of the tumor while the patient underwent pars plana vitrectomy, laser ablation, phacoemulsification with posterior chamber intraocular lens implantation, and intravitreal triamcinolone acetonide. In the other case the tissue was obtained after definite enucleation.Conclusion. Genetic expression profiling is a useful diagnostic tool for classification and can provide vital information to the ocular oncologist regarding prognosis.

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Intravitreal Dexamethasone Implant (Ozurdex®) for Exudative Retinal Detachment after Proton Beam Therapy for Choroidal Melanoma

European Journal of Ophthalmology ◽

10.5301/ejo.5000940 ◽

2017 ◽

Vol 27 (5) ◽

pp. 596-600 ◽

Cited By ~ 1

Author(s):

Ariane Malclès ◽

Anh-Minh Nguyen ◽

Thibaud Mathis ◽

Jean-Daniel Grange ◽

Laurent Kodjikian

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Proton Beam ◽

Safety Profile ◽

Choroidal Melanoma ◽

Case Series ◽

Proton Beam Therapy ◽

Exudative Retinal Detachment ◽

Dexamethasone Implant

Purpose To evaluate the efficacy and safety of intravitreal 0.7-mg dexamethasone implant (DEX-I) (Ozurdex®) in the treatment of extensive exudative retinal detachment (RD) associated with uveal melanoma treated using proton beam therapy (PBT). Methods Data from 10 patients with exudative RD after PBT treated with intravitreal injection of 0.7-mg DEX-I were reviewed retrospectively. The main outcome measures were resolution of exudative RD, visual acuity, and safety profile. Results Mean age was 55.6 years (range 34-85). Mean time between PBT and DEX-I was 12.4 months (range 3-25). Mean follow-up was 9.9 months (range 4-15). Intravitreal Ozurdex® reduced exudative RD in 7 cases (70%) on average 3.1 months after injection with complete resolution of RD in 6 of these (60%). For half of the patients, their level of vision remained stable; the other half experienced a deterioration in visual acuity at the end of follow-up. No adverse effects were observed. Conclusions In this small case series, treatment with intravitreal DEX-I reduced exudative RD in the majority of cases and had an acceptable safety profile.

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Safety and Efficacy of Hypo Fractionated Stereotactic Radiosurgery in Facial Nerve Schwannoma: a Single Institution Retrospective Case Series

10.21203/rs.3.rs-1153892/v1 ◽

2021 ◽

Author(s):

Nida Fatima ◽

Anna La Dine ◽

Zachary R Barnard ◽

Katherine Ko ◽

Kevin Peng ◽

...

Keyword(s):

Facial Nerve ◽

Stereotactic Radiosurgery ◽

Case Series ◽

Local Tumor Control ◽

Tumor Control ◽

Nerve Function ◽

Local Tumor ◽

Nerve Preservation ◽

Fractionated Stereotactic Radiosurgery

Abstract Background: In the current era of modern neurosurgery, the treatment strategies have been shifted to “nerve-preservation approaches” for achieving a higher facial and hearing function preservation rate following facial nerve tumors.Objective: We have conducted this novel report on determining the outcome of patients with facial nerve schwannomas (FNS) treated with hypo fractionated stereotactic radiosurgery (hfSRS).Methods: Retrospective chart review of a prospectively maintained database search was conducted. Patients who underwent hfSRS CyberKnife (Accuray Inc, Sunnyvale, California., USA) for FNS were included. Outcomes consisted of tumor control, facial and hearing nerve function as graded by House-Brackmann (HB) and Gardner-Robertson scale, and adverse radiation effects. SPSS 23 was used to perform statistical analysis.Results: With an institutional board review approval, we retrospectively identified 5 patients with FNS [4 intracranial (80%) and 1 extracranial (20%)] treated with hfSRS (2011-2019). Patients received definitive SRS in 3 patients (60.0%) wile adjuvant to surgical resection in 2 patients (40.0%). A median tumor volume of 7.5 cm3 (range, 1.5-19.6 cm3) received a median prescription dose of 23.2 Gy (range, 21-25 Gy) administered in median of 3 fractions (range, 3-5 session). With a median radiographic follow-up of 31.4 months (range, 13.0-71.0 months) and clinical follow-up of 32.6 months (range, 15.1-72.0 months), the local tumor control was 100.0%. At last clinical follow-up, the facial nerve function improved or remained unchanged HB I-II in 80.0% of the patients, while the hearing nerve function improved or remained stable in 100.0% (Gardner-Robertson I-II) of the patients. Temporary clinical toxicity was seen in 3 patients (60.0%) which resolved. None of the patient developed adverse radiation effect.Conclusion: From our case series, hfSRS in FNS seems to be safe and efficacious in terms of local tumor control, and improved facial and hearing nerve function.

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