How to Cite
Abstract
Introduction. Uveal melanoma (UM) is a primary adult malignancy with an aggressive course and high metastatic potential. At present, the generally accepted treatment for UM is brachytherapy. However, in cases where brachytherapy cannot be used to treat large tumors and the patient refuses to undergo enucleation of the eyeball, Gamma Knife stereotactic radiosurgery (GK SRS) can be used as an alternative.
Aim. To present a 10-year experience of treating patients with UM using GK SRS.
Materials and Methods. From 2012 to 2023, 80 UM patients (80 eyes) aged 13 to 77 years (mean age — 47 years) were treated with the GK SRS method. There were 47 (58 %) females and 33 (42 %) males, including 3 children aged 13, 14 and 17. Tumor height before treatment ranged from 3.1 to 10.8 mm (mean — 8.0 mm), basal diameter — from 8.7 to 20 mm (mean 13.8 mm). According to the international TNM system, the tumor was T3 in 56 (70 %) cases, T2 in 16 (20 %), T4 in 6 (7 %) and T1 in 2 (3 %). The prescribed dose was 40 Gy in 5 cases, 35 Gy in 12 cases, and 30 Gy in the remaining 63 cases with a 50 % isodose curve (from 32 to 67 %).
Results. The treated eye was spared in 94 % (n = 75) of cases. In all cases, these eyes were eligible for enucleation according to CR-2020 for the UM treatment, of which 3 were the only eyes. Eyes were enucleated in 5 cases (6 %) due to tumor progression on treatment (n = 3) and development of complications (n = 2). 16 (20 %) patients showed complete tumor regression, 61 (76 %) patients showed partial regression. The average tumor height after GK SRS was 5.6 mm (ranging from 1.6 to 11.5 mm), length — 14.08 mm (ranging from 8.7 to 20 mm). The average regression rate of the tumor was 30 %. Complications occurred in 88 % (n = 70) of cases: radiation retinopathy (n = 48, 68 %), radiation neuropathy (n = 6, 8 %), posterior capsular cataract (n = 6, 8 %), vitreous hemorrhage (n = 4, 5 %), uveitis (n = 3, 4 %) and neovascular glaucoma (n = 3, 4 %).
Conclusion. Our many years of experience with GK SRS on large UMs demonstrates the efficacy and safety of this technique.
References
Singh A.D, Turell M.E., Topham A.K. Uveal melanoma: trends in incidence, treatment, and survival. Ophthalmology. 2011; 118(9): 1881-5.-DOI: https://doi.org/10.1016/j.ophtha.2011.01.040.
Yarovoy A.A., Magaramov D.A., Bulgakova E.S. The comparison of ruthenium brachytherapy and simultaneous transpupillary thermotherapy of choroidal melanoma with brachytherapy alone. Brachytherapy. 2012; 11(3): 224-9.-DOI: https://doi.org/10.1016/j.brachy.2011.09.007.
Langmann G., Pendl G., Klaus-Müllne.r, et al. Gamma knife radiosurgery for uveal melanomas: an 8-year experience. J Neurosurg. 2000; 93 Suppl 3: 184-8.-DOI: https://doi.org/10.3171/jns.2000.93.supplement.
Guthoff R., von Domarus D., Schroeder W. Gegenüberstellung klinischer, echographischer und histologischer Befunde beim malignen Melanom der Aderhaut [Some correlations between ultrasonographic and histopathologic findings in malignant melanoma of the choroid (author's transl)]. Klin Monbl Augenheilkd. 1981; 179(5): 330-2.-DOI: https://doi.org/10.1055/s-2008-1057322.
Parker T., Rigney G., Kallos J., et al. Gamma knife radiosurgery for uveal melanomas and metastases: a systematic review and meta-analysis. Lancet Oncol. 2020; 21(11): 1526-1536.-DOI: https://doi.org/10.1016/S1470-2045(20)30459-9.
Logani S., Helenowski T.K., Thakrar H., Pothiawala B. Gamma Knife radiosurgery in the treatment of ocular melanoma. Stereotact Funct Neurosurg. 1993; 61 Suppl 1: 38-44.-DOI: https://doi.org/10.1159/000100658.
Logani S., Cho A.S., Su L.D., et al. Effects of gamma radiation on the OM431 human ocular melanoma cell line. Exp Eye Res. 1995; 60(6): 603-5-DOI: https://doi.org/10.1016/s0014-4835(05)80002-8.
Langmann G., Wackernagel W., Stücklschweiger G., et al. Dosis-Volumen-Histogramm-Regressionsanalyse von Aderhautmelanomen nach einzeitiger Leksell-Gamma-Knife-Radiochirurgie [Dose-volume histogram regression analysis of uveal melanomas after single fraction gamma knife radiosurgery]. Ophthalmologe. 2004; 101(11): 1111-9.-DOI: https://doi.org/10.1007/s00347-003-0984-y.
Langmann G., Pendl G., Müllner K., et al. High-compared with low-dose radiosurgery for uveal melanomas. J Neurosurg. 2002; 97(5 Suppl): 640-3.-DOI: https://doi.org/10.3171/jns.2002.97.supplement.
Dinca E.B., Yianni J., Rowe J., et al. Survival and complications following γ knife radiosurgery or enucleation for ocular melanoma: a 20-year experience. Acta Neurochir (Wien). 2012; 154(4): 605-10.-DOI: https://doi.org/10.1007/s00701-011-1252-6.
Müllner K., Langmann G., Pendl G., Faulborn J. Echographic findings in uveal melanomas treated with the Leksell gamma knife. Br J Ophthalmol. 1998; 82(2): 154-8.-DOI: https://doi.org/10.1136/bjo.82.2.154.
Modorati G.M., Dagan R., Mikkelsen L.H., et al. Gamma knife radiosurgery for uveal melanoma: a retrospective review of clinical complications in a tertiary referral center. Ocul Oncol Pathol. 2020; 6(2): 115-122.-DOI: https://doi.org/10.1159/000501971.
Cicinelli M.V., Di Nicola M., Gigliotti C.R., et al. Predictive factors of radio-induced complications in 194 eyes undergoing gamma knife radiosurgery for uveal melanoma. Acta Ophthalmol. 2021; 99(8): e1458-e1466.-DOI: https://doi.org/10.1111/aos.14814.
Zemba M., Dumitrescu O.M., Gheorghe A.G., et al. Ocular complications of radiotherapy in uveal melanoma. Cancers (Basel). 2023; 15(2): 333.-DOI: https://doi.org/10.3390/cancers15020333.
Osman I.M., Abouzeid H., Balmer A., et al. Modern cataract surgery for radiation-induced cataracts in retinoblastoma. Br J Ophthalmol. 2011; 95(2): 227-30.-DOI: https://doi.org/10.1136/bjo.2009.173401.
Fallico M., Chronopoulos A., Schutz J.S., Reibaldi M. Treatment of radiation maculopathy and radiation-induced macular edema: A systematic review. Surv Ophthalmol. 2021; 66(3): 441-460.-DOI: 10.1016/j.survophthal.2020.08.007.
Sarici A.M., Pazarli H. Gamma-knife-based stereotactic radiosurgery for medium- and large-sized posterior uveal melanoma. Graefes Arch Clin Exp Ophthalmol. 2013; 251(1): 285-94.-DOI: https://doi.org/10.1007/s00417-012-2144-z.
Клинические рекомендации «Увеальная меланома». Общероссийский национальный союз «Ассоциация онкологов России» Общероссийская общественная организация «Ассоциация врачей- офтальмологов». 2020. URL: content/uploads/2020/09/uvealnaja_melanoma.pdf?ysclid=lskf7cbqoy416489104. [Clinical recommendations “Uveal melanoma”. All-Russian National Union “Association of Oncologists of Russia” All-Russian public organization «Association of Ophthalmologists». 2020. URL: content/uploads/2020/09/uvealnaja_melanoma.pdf?ysclid=lskf7cbqoy416489104. (In Rus)].
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2024