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Uveal Melanoma

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CyberKnife NeuroRadiosurgery

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Abstract

Although rare, uveal melanoma is the most common primary intraocular cancer. These tumors threaten eyesight and shorten life expectancy via treatment-refractory liver metastases. Radiation treatments represent the most used means of achieving local control. Among the varied means of delivering ionizing radiation, image-guided photon radiosurgery represents an accessible, effective and noninvasive alternative. It remains to be defined which patients are best suited to radiosurgery as compared to the more commonly prescribed plaque brachytherapy or proton beam therapy.

Despite the lack of prospective confirmation, it is assumed that local treatment can impact overall survival as radiotherapy arrests tumor growth, and the risk of metastasis is known to increase with tumor size. Although organ preservation is common, long-term visual acuity is disappointing as radiation retinopathy is common.

As image-guided radiosurgery systems assume a fixed relationship between targets and the skull, the main technical challenge in radiosurgery is to ensure a reproducible relationship between the eyeball and the cranium. In proton beam therapy, targeting is accomplished though the suturing of tantalum fiducials to the sclera, whereas in image-guided radiosurgery, the preference is for less invasive methods—retrobulbar anesthesia, closed-eye treatment, or patient-assisted gaze fixation systems.

Using a fractionation scheme of 50 Gy in 5 fractions for medium-sized tumors, the aim should be to exceed 90% in 5-year local control and 80% in 5-year enucleation-free survival.

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References

  1. New cases and age-standardized rate for primary cancer (based on the May 2015 CCR tabulation file), by cancer type and sex, Canada, provinces and territories. 2016 March 11. http://www5.statcan.gc.ca/cansim/a05.

  2. Kaliki S, Shields CL. Uveal melanoma: relatively rare but deadly cancer. Eye (Lond). 2017;31(2):241–57.

    CAS  Google Scholar 

  3. Damato B. Does ocular treatment of uveal melanoma influence survival? Br J Cancer. 2010;103(3):285–90.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Lommatzsch PK, Lommatzsch R. Treatment of juxtapapillary melanomas. Br J Ophthalmol. 1991;75(12):715–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Seddon JM, et al. Uveal melanomas near the optic disc or fovea. Visual results after proton beam irradiation. Ophthalmology. 1987;94(4):354–61.

    CAS  PubMed  Google Scholar 

  6. Emara K, et al. Stereotactic radiotherapy in the treatment of juxtapapillary choroidal melanoma: preliminary results. Int J Radiat Oncol Biol Phys. 2004;59(1):94–100.

    PubMed  Google Scholar 

  7. Roberge D, et al. Treatment of medium-sized juxtapapillary melanoma with external Co-60 photon therapy. Radiother Oncol. 2005;74(1):71–3.

    PubMed  Google Scholar 

  8. Iskanderani O, et al. Reproducibility of a noninvasive system for eye positioning and monitoring in stereotactic radiotherapy of ocular melanoma. Technol Cancer Res Treat. 2017;16(3):352–6.

    PubMed  PubMed Central  Google Scholar 

  9. Recsan Z, et al. MRI for the evaluation of scleral invasion and extrascleral extension of uveal melanomas. Clin Radiol. 2002;57(5):371–6.

    PubMed  Google Scholar 

  10. Accuracy of diagnosis of choroidal melanomas in the Collaborative Ocular Melanoma Study. COMS report no. 1. Arch Ophthalmol. 1990;108(9):1268–73.

    Google Scholar 

  11. Khoja L, et al. Meta-analysis in metastatic uveal melanoma to determine progression-free and overall survival benchmarks: an international rare cancers initiative (IRCI) ocular melanoma study. Ann Oncol. 2019;30:1370.

    CAS  PubMed  Google Scholar 

  12. Rantala ES, Hernberg M, Kivela TT. Overall survival after treatment for metastatic uveal melanoma: a systematic review and meta-analysis. Melanoma Res. 2019;29(6):561–8.

    PubMed  PubMed Central  Google Scholar 

  13. Strobel K, et al. Limited value of 18F-FDG PET/CT and S-100B tumour marker in the detection of liver metastases from uveal melanoma compared to liver metastases from cutaneous melanoma. Eur J Nucl Med Mol Imaging. 2009;36(11):1774–82.

    CAS  PubMed  Google Scholar 

  14. Jampol LM, et al. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: IV. Local treatment failure and enucleation in the first 5 years after brachytherapy. COMS report no. 19. Ophthalmology. 2002;109(12):2197–206.

    PubMed  Google Scholar 

  15. Shields CL, et al. Primary transpupillary thermotherapy for small choroidal melanoma in 256 consecutive cases: outcomes and limitations. Ophthalmology. 2002;109(2):225–34.

    PubMed  Google Scholar 

  16. Harbour JW, et al. Transpupillary thermotherapy versus plaque radiotherapy for suspected choroidal melanomas. Ophthalmology. 2003;110(11):2207–14; discussion 2215.

    PubMed  Google Scholar 

  17. Reichstein D, Karan K. Endoresection utilizing pars plana vitrectomy for benign and malignant intraocular tumors. Curr Opin Ophthalmol. 2019;30(3):151–8.

    PubMed  Google Scholar 

  18. Roberge D, et al. Hypofractionated stereotactic radiotherapy for low grade glioma at McGill University: long-term follow-up. Technol Cancer Res Treat. 2006;5(1):1–8.

    CAS  PubMed  Google Scholar 

  19. Rennie I, et al. The use of single fraction Leksell stereotactic radiosurgery in the treatment of uveal melanoma. Acta Ophthalmol Scand. 1996;74(6):558–62.

    CAS  PubMed  Google Scholar 

  20. Sikuade MJ, et al. Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma. Eye (Lond). 2015;29(9):1194–8.

    CAS  Google Scholar 

  21. Verma V, Mehta MP. Clinical outcomes of proton radiotherapy for uveal melanoma. Clin Oncol (R Coll Radiol). 2016;28(8):e17–27.

    CAS  Google Scholar 

  22. Mishra KK, et al. Long-term results of the UCSF-LBNL randomized trial: charged particle with helium ion versus Iodine-125 plaque therapy for choroidal and ciliary body melanoma. Int J Radiat Oncol Biol Phys. 2015;92(2):376–83.

    PubMed  Google Scholar 

  23. Nag S, et al. The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas. Int J Radiat Oncol Biol Phys. 2003;56(2):544–55.

    PubMed  Google Scholar 

  24. Weber DC, et al. Proton beam radiotherapy versus fractionated stereotactic radiotherapy for uveal melanomas: a comparative study. Int J Radiat Oncol Biol Phys. 2005;63(2):373–84.

    PubMed  Google Scholar 

  25. Daftari IK, et al. Newer radiation modalities for choroidal tumors. Int Ophthalmol Clin. 2006;46(1):69–79.

    PubMed  Google Scholar 

  26. Gragoudas ES, et al. A randomized controlled trial of varying radiation doses in the treatment of choroidal melanoma. Arch Ophthalmol. 2000;118(6):773–8.

    CAS  PubMed  Google Scholar 

  27. Dunavoelgyi R, et al. Local tumor control, visual acuity, and survival after hypofractionated stereotactic photon radiotherapy of choroidal melanoma in 212 patients treated between 1997 and 2007. Int J Radiat Oncol Biol Phys. 2011;81(1):199–205.

    PubMed  Google Scholar 

  28. Fernandes BF, et al. Neovascular glaucoma after stereotactic radiotherapy for juxtapapillary choroidal melanoma: histopathologic and dosimetric findings. Int J Radiat Oncol Biol Phys. 2011;80(2):377–84.

    PubMed  Google Scholar 

  29. van den Bosch T, et al. Risk factors associated with secondary enucleation after fractionated stereotactic radiotherapy in uveal melanoma. Acta Ophthalmol. 2015;93(6):555–60.

    PubMed  Google Scholar 

  30. Groenewald C, Konstantinidis L, Damato B. Effects of radiotherapy on uveal melanomas and adjacent tissues. Eye (Lond). 2013;27(2):163–71.

    CAS  Google Scholar 

  31. Haji Mohd Yasin NA, et al. Choroidal melanoma treated with stereotactic fractionated radiotherapy and prophylactic intravitreal bevacizumab: the Dunedin Hospital experience. J Med Imaging Radiat Oncol. 2016;60(6):756–63.

    PubMed  Google Scholar 

  32. Scaringi C, et al. Radiation-induced malignant meningioma following proton beam therapy for a choroidal melanoma. J Clin Neurosci. 2015;22(6):1036–7.

    PubMed  Google Scholar 

  33. Pantelis E, et al. Radiation dose to the fetus during CyberKnife radiosurgery for a brain tumor in pregnancy. Phys Med. 2016;32(1):237–41.

    PubMed  Google Scholar 

  34. Chabert S, Velikay-Parel M, Zehetmayer M. Influence of uveal melanoma therapy on patients’ quality of life: a psychological study. Acta Ophthalmol Scand. 2004;82(1):25–31.

    PubMed  Google Scholar 

  35. Miniati M, et al. Quality of life, depression, and anxiety in patients with uveal melanoma: a review. J Oncol. 2018;2018:5253109.

    PubMed  PubMed Central  Google Scholar 

  36. Moschos MM, et al. Depression in choroidal melanoma patients treated with proton beam radiotherapy. Anticancer Res. 2018;38(5):3055–61.

    CAS  PubMed  Google Scholar 

  37. Melia M, et al. Quality of life after iodine 125 brachytherapy vs enucleation for choroidal melanoma: 5-year results from the collaborative ocular melanoma study: COMS QOLS report no. 3. Arch Ophthalmol. 2006;124(2):226–38.

    PubMed  Google Scholar 

  38. Beliveau-Nadeau D, Callejo S, Roberge D. Technique for robotic stereotactic irradiation of choroidal melanoma. Cureus. 2016;8(4):e582.

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Centre Hospitalier de L’Université de Montréal (CHUM), Montreal, Canada

    David Roberge

  2. Department of Radiology, Radiation Oncology and Nuclear Medicine, University of Montreal, Montreal, Canada

    David Roberge

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  1. David Roberge
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Correspondence to David Roberge .

Editor information

Editors and Affiliations

  1. Associate Professor of Neurosurgery, Alma Mater Studiorum University of Bologna, Bologna, Italy

    Alfredo Conti

  2. Scientific Director, AB Medica, Milano, Italy

    Pantaleo Romanelli

  3. Assistant Professor, Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Evangelos Pantelis

  4. Associate Professor, Department of Radiation Oncology, Stanford University Cancer Center, Stanford, CA, USA

    Scott G. Soltys

  5. Associate Professor, Department of Neurosurgery and Radiosurgery Center, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea (Republic of)

    Young Hyun Cho

  6. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Lim

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Roberge, D. (2020). Uveal Melanoma. In: Conti, A., Romanelli, P., Pantelis, E., Soltys, S., Cho, Y., Lim, M. (eds) CyberKnife NeuroRadiosurgery . Springer, Cham. https://doi.org/10.1007/978-3-030-50668-1_35

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