Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy☆
Section snippets
Materials and methods
We retrospectively reviewed all uveal melanoma patients we treated with helium ions (n = 348), protons (n = 199), or 125I brachytherapy (n = 449) between 1978 and 2000 to assess the occurrence rate of late failures, defined as those detected at least 5 years after treatment. All patients were evaluated and treated in a standardized manner and were part of ongoing phase I, II, and III treatment trials. The surgical, radiation planning, and follow-up protocols were identical throughout the period
Results
In irradiated uveal melanoma patients treated with brachytherapy, 58 of 449 uveal melanomas recurred locally with a mean interval between treatment and detection of recurrent growth of 3.6 years; the median was 2.9 years (range, 0.2–15.3 years). In contrast, after charged-particle therapy, intraocular tumor recurrence developed in 22 of 547 patients (15 of whom received helium ions and 7 of whom were treated with protons). The mean duration between treatment and the detection of intraocular
Discussion
In our experience with charged-particle uveal melanoma radiation, the longest time between radiation and detection of intraocular melanoma recurrence is approximately 5 years, with a mean interval of 1.6 years.14 Similar data has been published from Gragoudas9 and Gragoudas et al17 in Boston; they observed one failure 10 years after proton radiation. In contrast, we report 11 cases of late intraocular radiation failures after 125I brachytherapy between 5.5 to 15 years after treatment. The
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Pattern of Local Recurrence After I-125 Episcleral Brachytherapy for Uveal Melanoma in a Spanish Referral Ocular Oncology Unit
2017, American Journal of OphthalmologyLocal Failure After Episcleral Brachytherapy for Posterior Uveal Melanoma: Patterns, Risk Factors, and Management
2017, American Journal of OphthalmologyCitation Excerpt :The majority (90.5%) of the recurrences occurred within the first 5 years (Figure 1). Although several studies have reported very late local tumor recurrence up to 15 years after brachytherapy, late recurrence remains rare and accounts for only 2 cases in our study (more than 5 years after brachytherapy).13,16,17,19 Owing to the low risk of recurrence beyond 5 years, less intense monitoring may be considered beyond this follow-up period.
Clinical Outcomes of Proton Radiotherapy for Uveal Melanoma
2016, Clinical OncologyCitation Excerpt :These data did not include visual acuity outcomes, but in a previous analysis of 440 patients [15] with visual acuity data, 91.6% had visual acuity better than 20/160 before PBT and 35% of patients had vision worse than 20/200 after PBT. At the University of California, San Francisco, early data compared outcomes in a non-randomised and retrospective manner between particle therapy (PBT and helium ions) and iodine-125 brachytherapy with a 54 month follow-up [16]. Of 996 patients, 199 received PBT at a dose of 56 Gy (RBE).
Local Recurrence Significantly Increases the Risk of Metastatic Uveal Melanoma
2016, OphthalmologyCitation Excerpt :This study provides evidence that local recurrence significantly increases the risk of metastasis despite the type of primary tumor treatment. Local radiation failure has been attributed to radiation resistance, misplacement of radioactive plaque, insufficient radiotherapeutic margins, and eye movement (primarily during charged-particle beam therapy).5,14 Therefore, our findings support the use of methods to improve local control (e.g., intraoperative ultrasound to evaluate plaque placement, slotted plaque radiotherapy, 2–3-mm radiotherapeutic margins, adequate tumor dose and eye fixation during external beam techniques).15–20
Disease control and toxicity outcomes using ruthenium eye plaque brachytherapy in the treatment of uveal melanoma
2014, Practical Radiation Oncology
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Supported in part by a grant from the Tumori Foundation, San Francisco, California, and the University of California, San Francisco, California.