International Journal of Radiation Oncology*Biology*Physics
Clinical investigationStereotactic radiotherapy in the treatment of juxtapapillary choroidal melanoma: preliminary results
Introduction
Uveal melanoma, a rare malignancy, is the most common primary intraocular tumor in adults (1). Enucleation had been the standard therapy until a recent randomized study of brachytherapy vs. enucleation concluded that primary therapy with radiation was not detrimental to survival (2). However, eye-conserving therapy for juxtapapillary choroidal melanoma poses a particular challenge because of its proximity to the optic nerve and macula. A number of management options, including enucleation, modified brachytherapy, charged particle radiation, helium ion therapy, and transpupillary thermotherapy, have been evaluated in this regard 3, 4, 5, 6, 7, 8, 9. However, the efficacy of stereotactic radiotherapy (10) in the management of juxtapapillary choroidal melanoma has not been extensively reviewed in the literature. Stereotactic radiotherapy for juxtapapillary choroidal melanoma has been used at our center since 1998; preliminary results are evaluated in this study.
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Methods and materials
We conducted a retrospective chart review of all patients with juxtapapillary choroidal melanoma who had been treated with stereotactic radiotherapy between October 1998 and May 2001 in the Ocular Oncology Service at Princess Margaret Hospital, Toronto, Canada. Ethics approval was obtained from the Princess Margaret Hospital ethics board.
Baseline patient data included demographics, a full ophthalmologic evaluation, fundus photography, and A-/B-scan ultrasonography. All patients had a complete
Demographic and preoperative data
Twenty-eight patients were included in the analysis with a mean age of 61 years. Nineteen patients were male and 9 were female. There were 15 right eyes and 13 left eyes. Two patients had diabetes mellitus, 11 had hypertension, and 4 had coronary artery disease. Two patients had a medical history of primary nonocular cancer.
Tumor characteristics
All tumors were juxtapapillary (Table 1). The median distance between the posterior edge of the tumor and the optic nerve was 0 mm (range, 0 mm–2.0 mm). The median distance
Discussion
Although this retrospective study has a median follow-up of only 18 months, few studies have evaluated stereotactic radiotherapy in the treatment of choroidal melanoma. Moreover, we analyzed a homogeneous population of patients, all with tumors within 2 mm of the optic disc.
Close proximity of choroidal melanoma to the optic nerve has been reported to be a risk factor for local treatment failure and melanoma-specific mortality 2, 14, 15. The Collaborative Ocular Melanoma Study (2) found no
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2011, International Journal of Radiation Oncology Biology PhysicsNeovascular glaucoma after stereotactic radiotherapy for juxtapapillary choroidal melanoma: Histopathologic and dosimetric findings
2011, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :Radiation-induced neovascular glaucoma (NVG) diagnosed by neovascularization of the iris or angle and elevated intraocular pressure is the main radiation-induced complication requiring enucleation (9). On the basis of our reported experience with SRT for juxtapapillary melanoma (6–8), we present a detailed pathologic analysis of eyes enucleated for NVG or tumor progression and correlate these findings with dose–volume histogram (DVH) data based on relevant contoured anatomy features (optic nerve head, retina, and anterior chamber). Even though there have been reports on the histopathologic changes of enucleated eyes after different forms of radiotherapy for uveal melanoma (10–15), to our knowledge, this is the first study to detail pathologic changes due to SRT for juxtapapillary tumors.