Shahed N Badiyan1, Rajesh C Rao2, Anthony J Apicelli1, Sahaja Acharya1, Vivek Verma1, Adam A Garsa1, Todd DeWees1, Christina K Speirs1, Jose Garcia-Ramirez1, Jacqueline Esthappan1, Perry W Grigsby1, J William Harbour3. 1. Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri. 2. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri. 3. Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri; Ocular Oncology Service, Department of Ophthalmology, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: JWHarbour@med.miami.edu.
Abstract
PURPOSE: To assess the impact on local tumor control of intraoperative ultrasonographic plaque visualization and selective application of transpupillary thermotherapy (TTT) in the treatment of posterior uveal melanoma with iodine-125 (I-125) episcleral plaque brachytherapy (EPB). METHODS AND MATERIALS: Retrospective analysis of 526 patients treated with I-125 EPB for posterior uveal melanoma. Clinical features, dosimetric parameters, TTT treatments, and local tumor control outcomes were recorded. Statistical analysis was performed using Cox proportional hazards and Kaplan-Meier life table method. RESULTS: The study included 270 men (51%) and 256 women (49%), with a median age of 63 years (mean, 62 years; range, 16-91 years). Median dose to the tumor apex was 94.4 Gy (mean, 97.8; range, 43.9-183.9) and to the tumor base was 257.9 Gy (mean, 275.6; range, 124.2-729.8). Plaque tilt >1 mm away from the sclera at plaque removal was detected in 142 cases (27%). Supplemental TTT was performed in 72 patients (13.7%). One or 2 TTT sessions were required in 71 TTT cases (98.6%). After a median follow-up of 45.9 months (mean, 53.4 months; range, 6-175 months), local tumor recurrence was detected in 19 patients (3.6%). Local tumor recurrence was associated with lower dose to the tumor base (P=.02). CONCLUSIONS: Ultrasound-guided plaque localization of I-125 EPB is associated with excellent local tumor control. Detection of plaque tilt by ultrasonography at plaque removal allows supplemental TTT to be used in patients at potentially higher risk for local recurrence while sparing the majority of patients who are at low risk. Most patients require only 1 or 2 TTT sessions.
PURPOSE: To assess the impact on local tumor control of intraoperative ultrasonographic plaque visualization and selective application of transpupillary thermotherapy (TTT) in the treatment of posterior uveal melanoma with iodine-125 (I-125) episcleral plaque brachytherapy (EPB). METHODS AND MATERIALS: Retrospective analysis of 526 patients treated with I-125 EPB for posterior uveal melanoma. Clinical features, dosimetric parameters, TTT treatments, and local tumor control outcomes were recorded. Statistical analysis was performed using Cox proportional hazards and Kaplan-Meier life table method. RESULTS: The study included 270 men (51%) and 256 women (49%), with a median age of 63 years (mean, 62 years; range, 16-91 years). Median dose to the tumor apex was 94.4 Gy (mean, 97.8; range, 43.9-183.9) and to the tumor base was 257.9 Gy (mean, 275.6; range, 124.2-729.8). Plaque tilt >1 mm away from the sclera at plaque removal was detected in 142 cases (27%). Supplemental TTT was performed in 72 patients (13.7%). One or 2 TTT sessions were required in 71 TTT cases (98.6%). After a median follow-up of 45.9 months (mean, 53.4 months; range, 6-175 months), local tumor recurrence was detected in 19 patients (3.6%). Local tumor recurrence was associated with lower dose to the tumor base (P=.02). CONCLUSIONS: Ultrasound-guided plaque localization of I-125 EPB is associated with excellent local tumor control. Detection of plaque tilt by ultrasonography at plaque removal allows supplemental TTT to be used in patients at potentially higher risk for local recurrence while sparing the majority of patients who are at low risk. Most patients require only 1 or 2 TTT sessions.
Authors: Jacqueline Esthappan Zoberi; Jose Garcia-Ramirez; Samantha Hedrick; Vivian Rodriguez; Carol G Bertelsman; Stacie Mackey; Yanle Hu; H Michael Gach; P Kumar Rao; Perry W Grigsby Journal: Brachytherapy Date: 2017-08-14 Impact factor: 2.362
Authors: Beatriz Quiles; Jorge Mataix; José Luis Guinot; Isabel Wang; Victor De Los Dolores; Marina Peña; Alonso La Rosa; Maribel Tortajada; Miguel Santos; Leoncio Arribas Journal: Ocul Oncol Pathol Date: 2021-05-05
Authors: Manuel Paez-Escamilla; Scott D Walter; Amir Mohsenin; Christina L Decatur; George J Harocopos; Sander Dubovy; J William Harbour Journal: Ophthalmic Surg Lasers Imaging Retina Date: 2019-09-01 Impact factor: 1.300
Authors: H Michael Gach; Stacie L Mackey; Sana Rehman; Mo Kadbi; Jacqueline E Zoberi; Jose Garcia-Ramirez; Perry W Grigsby Journal: J Contemp Brachytherapy Date: 2017-10-30