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Comparison of iodine-125 plaque brachytherapy and gamma knife stereotactic radiosurgery treatment outcomes for uveal melanoma patients

  • Oncology
  • Published:
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Abstract

Purpose

To compare the efficacies of iodine-125 brachytherapy (IBT) and gamma knife stereotactic radiosurgery (GKRS) in the treatment of posterior uveal melanoma.

Methods

The demographic data and tumor characteristics at diagnosis of 201 patients treated with IBT and 52 patients treated with GKRS were recorded. The two treatments were then compared in terms of complications, local control, eye retention, metastasis, and overall survival rate.

Results

The median follow-up time was 56 months for the GKRS group and 45 months for the IBT group (p = 0.167). There were no significant differences in demographic data or tumor characteristics between the groups at diagnosis. Radiation retinopathy, radiation optic neuropathy, and neovascular glaucoma occurred at similar rates in both groups. However, radiation maculopathy and cataracts occurred more frequently in the GKRS group. The number of cases that have developed vision loss (worsening of best-corrected visual acuity on three or more lines on the Snellen chart) was significantly higher in the GKRS group (60%) compared to the IBT group (44%) (p = 0.048). Local control, metastasis, and 5-year overall survival rates were statistically similar in both groups.

Conclusions

GKRS can be preferred as an eye-sparing treatment option for posterior uveal melanoma in cases where brachytherapy cannot be used.

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Data availability

All data related to the study are included in the article.

Code availability

Not applicable.

Abbreviations

UM:

Uveal melanoma

IBT:

İOdine-125 brachytherapy

GKRS:

Gamma knife stereotactic radiosurgery

BCVA:

Best-corrected visual acuity

IOP:

Intraocular pressure

USG:

Ultrasonography

CT:

Computed tomography

PET:

Positron emission tomography

AJCC:

The American Joint Committee on Cancer

RR:

Radiation retinopathy

RON:

Radiation optic neuropathy

NVG:

Neovascular glaucoma

RM:

Radiation maculopathy

COMS:

The Collaborative Ocular Melanoma Study

SRT:

Stereotactic radiotherapy

LINAC:

Linear accelerator

References

  1. Aronow ME, Topham AK, Singh AD (2018) Uveal Melanoma: 5-Year Update on Incidence, Treatment, and Survival (SEER 1973–2013). Ocul Oncol Pathol 4:145–151. https://doi.org/10.1159/000480640

    Article  PubMed  Google Scholar 

  2. Singh M, Durairaj P, Yeung J (2018) Uveal Melanoma: A Review of the Literature. Oncol Ther 6:87–104. https://doi.org/10.1007/s40487-018-0056-8

    Article  PubMed  PubMed Central  Google Scholar 

  3. Shields JA, Shields CL (2015) Management of posterior uveal melanoma: past, present, and future: the 2014 Charles L. Schepens lecture. Ophthalmology 122:414–428. https://doi.org/10.1016/j.ophtha.2014.08.046

    Article  Google Scholar 

  4. Collaborative Ocular Melanoma Study Group (2006) The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol (Chicago Ill 1960) 124:1684–93. https://doi.org/10.1001/archopht.124.12.1684

    Article  Google Scholar 

  5. Jampol LM, Moy CS, Murray TG et al (2002) 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 109:2197–2206. https://doi.org/10.1016/s0161-6420(02)01277-0

    Article  PubMed  Google Scholar 

  6. Kaliki S, Shields CL (2017) Uveal melanoma: relatively rare but deadly cancer. Eye (Lond) 31:241–257. https://doi.org/10.1038/eye.2016.275

    Article  CAS  Google Scholar 

  7. Shields CL, Cater J, Shields JA et al (2002) Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: tumor control and treatment complications in 270 consecutive patients. Arch Ophthalmol (Chicago Ill 1960) 120:933–40. https://doi.org/10.1001/archopht.120.7.933

    Article  Google Scholar 

  8. Vonk DT, Kim Y, Javid C et al (2015) Prescribing to tumor apex in episcleral plaque iodine-125 brachytherapy for medium-sized choroidal melanoma: A single-institutional retrospective review. Brachytherapy 14:726–733. https://doi.org/10.1016/j.brachy.2015.05.002

    Article  PubMed  Google Scholar 

  9. Finger PT, Chin KJ, Duvall G, Palladium-103 for Choroidal Melanoma Study Group (2009) Palladium-103 ophthalmic plaque radiation therapy for choroidal melanoma: 400 treated patients. Ophthalmology 116:790–6-796.e1. https://doi.org/10.1016/j.ophtha.2008.12.027

    Article  Google Scholar 

  10. Correa R, Pera J, Gómez J et al (2009) (125)I episcleral plaque brachytherapy in the treatment of choroidal melanoma: a single-institution experience in Spain. Brachytherapy 8:290–296. https://doi.org/10.1016/j.brachy.2009.03.189

    Article  PubMed  Google Scholar 

  11. Mueller AJ, Talies S, Schaller UC et al (2000) Stereotactic radiosurgery of large uveal melanomas with the gamma-knife. Ophthalmology 107:1381–7. https://doi.org/10.1016/s0161-6420(00)00150-0 (discussion 1387-8)

    Article  CAS  PubMed  Google Scholar 

  12. Fakiris AJ, Lo SS, Henderson MA et al (2007) Gamma-knife-based stereotactic radiosurgery for uveal melanoma. Stereotact Funct Neurosurg 85:106–112. https://doi.org/10.1159/000098525

    Article  PubMed  Google Scholar 

  13. Sarici AM, Pazarli H (2013) Gamma-knife-based stereotactic radiosurgery for medium- and large-sized posterior uveal melanoma. Graefes Arch Clin Exp Ophthalmol 251:285–294. https://doi.org/10.1007/s00417-012-2144-z

    Article  PubMed  Google Scholar 

  14. Joye RP, Williams LB, Chan MD et al (2014) Local Control and Results of Leksell Gamma Knife Therapy for the Treatment of Uveal Melanoma. Ophthalmic Surg Lasers Imaging Retina 45:125–131. https://doi.org/10.3928/23258160-20140306-05

    Article  PubMed  Google Scholar 

  15. Modorati GM, Dagan R, Mikkelsen LH et al (2020) Gamma Knife Radiosurgery for Uveal Melanoma: A Retrospective Review of Clinical Complications in a Tertiary Referral Center. Ocul Oncol Pathol 6:115–122. https://doi.org/10.1159/000501971

    Article  PubMed  Google Scholar 

  16. Damato B, Kacperek A, Errington D, Heimann H (2013) Proton beam radiotherapy of uveal melanoma. Saudi J Ophthalmol Off J Saudi Ophthalmol Soc 27:151–157. https://doi.org/10.1016/j.sjopt.2013.06.014

    Article  Google Scholar 

  17. Dunavoelgyi R, Dieckmann K, Gleiss A et al (2011) 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 81:199–205. https://doi.org/10.1016/j.ijrobp.2010.04.035

    Article  PubMed  Google Scholar 

  18. Macdonald ECA, Cauchi P, Kemp EG (2011) Proton beam therapy for the treatment of uveal melanoma in Scotland. Br J Ophthalmol 95:1691–1695. https://doi.org/10.1136/bjo.2010.195594

    Article  PubMed  Google Scholar 

  19. Hamrouni Z, Levy C, Lumbroso L et al (2005) Results of treating uveal melanoma with proton beam radiation: 10-year follow-up. J Fr Ophtalmol 28:833–839. https://doi.org/10.1016/s0181-5512(05)81001-0

    Article  CAS  PubMed  Google Scholar 

  20. Zambrano AD, Chinela AB, Bunge HJ (1989) Stereotactic radiosurgery for uveal melanomas. Protocol for treatment. Archivos Ophthalmol Buenos Aires 64:49–54

    Google Scholar 

  21. Arnett ALH, Reynolds MM, Pulido JS et al (2017) Gamma Knife Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Ocular Malignancies. Stereotact Funct Neurosurg 95:363–368. https://doi.org/10.1159/000478271

    Article  PubMed  Google Scholar 

  22. Shields CL, Kaliki S, Furuta M et al (2012) Clinical spectrum and prognosis of uveal melanoma based on age at presentation in 8,033 cases. Retina 32:1363–1372. https://doi.org/10.1097/IAE.0b013e31824d09a8

    Article  PubMed  Google Scholar 

  23. Kaliki S, Shields CL, Shields JA (2015) Uveal melanoma: estimating prognosis. Indian J Ophthalmol 63:93–102. https://doi.org/10.4103/0301-4738.154367

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zloto O, Pe’er J, Frenkel S (2013) Gender differences in clinical presentation and prognosis of uveal melanoma. Invest Ophthalmol Vis Sci 54:652–6. https://doi.org/10.1167/iovs.12-10365

    Article  PubMed  Google Scholar 

  25. Shields CL, Kaliki S, Furuta M et al (2013) American Joint Committee on Cancer classification of posterior uveal melanoma (tumor size category) predicts prognosis in 7731 patients. Ophthalmology 120:2066–2071. https://doi.org/10.1016/j.ophtha.2013.03.012

    Article  PubMed  Google Scholar 

  26. Shields CL, Furuta M, Thangappan A et al (2009) Metastasis of uveal melanoma millimeter-by-millimeter in 8033 consecutive eyes. Arch Ophthalmol (Chicago Ill 1960) 127:989–98. https://doi.org/10.1001/archophthalmol.2009.208

    Article  Google Scholar 

  27. Gündüz K, Shields CL, Shields JA et al (1999) Radiation retinopathy following plaque radiotherapy for posterior uveal melanoma. Arch Ophthalmol (Chicago, Ill 1960) 117:609–14. https://doi.org/10.1001/archopht.117.5.609

    Article  Google Scholar 

  28. Finger PT, Chin KJ, Yu G-P, Palladium-103 for Choroidal Melanoma Study Group (2010) Risk factors for radiation maculopathy after ophthalmic plaque radiation for choroidal melanoma. Am J Ophthalmol 149:608–15. https://doi.org/10.1016/j.ajo.2009.11.006

    Article  PubMed  Google Scholar 

  29. Haas A, Pinter O, Papaefthymiou G et al (2002) Incidence of radiation retinopathy after high-dosage single-fraction gamma knife radiosurgery for choroidal melanoma. Ophthalmology 109:909–913. https://doi.org/10.1016/S0161-6420(02)01011-4

    Article  PubMed  Google Scholar 

  30. Mishra KK, Daftari IK, Weinberg V et al (2013) Risk factors for neovascular glaucoma after proton beam therapy of uveal melanoma: a detailed analysis of tumor and dose-volume parameters. Int J Radiat Oncol Biol Phys 87:330–336. https://doi.org/10.1016/j.ijrobp.2013.05.051

    Article  PubMed  Google Scholar 

  31. Shields CL, Naseripour M, Cater J et al (2002) Plaque radiotherapy for large posterior uveal melanomas (> or =8-mm thick) in 354 consecutive patients. Ophthalmology 109:1838–1849. https://doi.org/10.1016/s0161-6420(02)01181-8

    Article  PubMed  Google Scholar 

  32. Siedlecki J, Reiterer V, Leicht S et al (2017) Incidence of secondary glaucoma after treatment of uveal melanoma with robotic radiosurgery versus brachytherapy. Acta Ophthalmol 95:e734–e739. https://doi.org/10.1111/aos.13418

    Article  PubMed  Google Scholar 

  33. Bianciotto C, Shields CL, Pirondini C et al (2010) Proliferative radiation retinopathy after plaque radiotherapy for uveal melanoma. Ophthalmology 117:1005–1012. https://doi.org/10.1016/j.ophtha.2009.10.015

    Article  PubMed  Google Scholar 

  34. Krema H, Heydarian M, Beiki-Ardakani A et al (2013) Dosimetric and late radiation toxicity comparison between iodine-125 brachytherapy and stereotactic radiation therapy for juxtapapillary choroidal melanoma. Int J Radiat Oncol Biol Phys 86:510–515. https://doi.org/10.1016/j.ijrobp.2013.02.005

    Article  PubMed  Google Scholar 

  35. Mazzini C, Pieretti G, Vicini G et al (2021) Clinical outcomes and secondary glaucoma after gamma-knife radiosurgery and Ruthenium-106 brachytherapy for uveal melanoma: a single institution experience. Melanoma Res 31:38–48. https://doi.org/10.1097/CMR.0000000000000689

    Article  CAS  PubMed  Google Scholar 

  36. Dinca EB, Yianni J, Rowe J et al (2012) Survival and complications following Gamma Knife radiosurgery or enucleation for ocular melanoma: a 20-year experience. Acta Neurochir (Wien) 154:605–610. https://doi.org/10.1007/s00701-011-1252-6

    Article  Google Scholar 

  37. Foss AJE, Whelehan I, Hungerford JL et al (1997) Predictive factors for the development of rubeosis following proton beam radiotherapy for uveal melanoma. Br J Ophthalmol 81:748–754. https://doi.org/10.1136/bjo.81.9.748

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Riechardt AI, Pilger D, Cordini D et al (2017) Neovascular glaucoma after proton beam therapy of choroidal melanoma: incidence and risk factors. Graefes Arch Clin Exp Ophthalmol 255:2263–2269. https://doi.org/10.1007/s00417-017-3737-3

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, Sivas Numune Hospital, Sivas, Turkey

    Umit Yasar Guleser

  2. Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul Unıversity - Cerrahpasa, Istanbul, 34098, Turkey

    Ahmet Murat Sarici & Didar Ucar

  3. Department of Ophthalmology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey

    Busenur Gonen

  4. Department of Internal Medicine, Division of Medical Oncology, Cerrahpaşa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey

    Nilay Sengul Samanci & Mustafa Özgüroğlu

Authors
  1. Umit Yasar Guleser
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  2. Ahmet Murat Sarici
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  3. Didar Ucar
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Correspondence to Ahmet Murat Sarici.

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The consent of the Ethics Committee of Cerrahpasa Medical Faculty, Istanbul University – Cerrahpasa, Turkey, was obtained prior to the study. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Guleser, U.Y., Sarici, A.M., Ucar, D. et al. Comparison of iodine-125 plaque brachytherapy and gamma knife stereotactic radiosurgery treatment outcomes for uveal melanoma patients. Graefes Arch Clin Exp Ophthalmol 260, 1337–1343 (2022). https://doi.org/10.1007/s00417-021-05472-x

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