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- Title
Fractionated stereotactic radiotherapy for uveal melanoma: Early results.
- Authors
Zanetti, Isa Bossi; Pellegrini, Marco; Beltramo, Giancarlo; Preziosa, Chiara; Martinotti, Anna Stefania; Redaelli, Irene; Spadavecchia, Chiara; Moretti, Francesco; Bianchi, Livia Corinna; Papa, Sergio; Staurenghi, Giovanni
- Abstract
Aim: We report our clinical experience of a hypofractionated Cyberknife radiotherapy treatment for uveal melanoma. Methods: We retrospectively evaluated 47 patients (pts), mean age 68 years (range 36 - 90 years) suffering from uveal melanoma treated by Cyberknife, Centro Diagnostico Italiano, Milan, Italy, between April 2014 and December 2020. All of the pts had received a diagnosis and referral from an ophthalmologist. Cyberknife robot-controlled LINAC radiosurgery was performed delivering a total dose of 54 - 60 Gy given in 3 fractions of 18 - 20 Gy prescribed to the 79 - 82% isodose surface. All pts underwent orbit MRI with gadolinium (slices thickness 1 mm) for coregistration with the planning CT scans. The planning target volume (PTV) included the contrast-enhancing lesion on MRI (GTV = CTV) plus a 2.5 mm margins in all directions. All pts were irradiated eyelids closed, with a bandage on eye, using a contention with a thermoplastic mask. For 9 pts tantalium markers were sutured to the sclera around the tumor. At presentation the mean PTV volume was 1857 mm³ (range 100 – 5792 mm³), mean tumor base measured ultrasonographically 11.7 mm (range 6-20 mm) and mean thickness 4.8 mm (range 2-10 mm). Results: After a mean follow-up of 37 months (range 8 – 84 months) local control was achieved in 100% of pts. We observed a reduction of 7% in mean base and of 41% in mean thickness that were respectively 10.9 mm (range 4 – 20 mm) and 2.8 mm (range 0.5 – 9 mm) at follow-up. The most common side effects were radiation maculopathy in 27 pts (57%), cataract in 15 pts (32%), choroidal ischemia in 16 pts (34%). 9 pts (19%) suffered from radiation neuropathy, 10 pts (21%) from retinal detachment and 5 pts (10%) from neovascular glaucoma which required enucleation in 4 pts (8%). To reduce toxicity intravitreal anti-VEGF (+/- photodynamic terapy) and steroids 4 months after the treatment were performed to the most of patients (72%). Visual acuity was reduced in 34 pts (72%), increased in 4 pts (7%) while in the others 10 pts (21%) no change was found. Conclusions: Our results are consistent with data in literature and show a safe, minimally invasive and well tolerated method for treating uveal melanoma. The main limitation is that it is a retrospective study. Continued accrual and follow-up are required to confirm long term results.
- Subjects
MILAN (Italy); UVEA cancer; STEREOTACTIC radiotherapy; MELANOMA; RETINAL detachment; VISUAL acuity; COMPUTED tomography
- Publication
Journal of Radiosurgery & SBRT, 2022, Vol 8, p138
- ISSN
2156-4639
- Publication type
Article