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Plaque Radiotherapy (plaque + radiotherapy)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

3143: Management of iris melanomas with 125 iodine plaque radiotherapy

ACTA OPHTHALMOLOGICA, Issue 2010
BF FERNANDES
Purpose The experience with 125Iodine (I125) plaque brachytherapy in the treatment of IM at the Princess Margaret Hospital/University Health Network is the subject of the report to follow. Methods All cases of IM submitted to I125 plaque radiotherapy were included. Patients' demographic, clinical, management, and follow-up data were reviewed. Outcome measures included rates of tumor control, eye preservation, systemic metastases, and brachytherapy-related complications. Results Fourteen IMs were included in the study. All patients had blue/green irises. Mean largest basal dimension and thickness were 7.1 +/- 2.1 mm (range, 4.0 to 11.5 mm) and 2.2 +/- 0.8 mm (range, 1.0 to 3.5 mm), respectively. Ten patients (71%) had seeding and 2 (14%) had glaucoma at presentation. Median follow-up was 26.6 +/- 19.5 months (range, 6 to 72 months). Tumor control was achieved in 100% of the cases and no eye was enucleated because of radiation-induced complications. At last visit, all patients were alive and free of metastasis. Final visual acuity was the same as or better than before treatment in 9 patients (75%). Cataract was the most common complication (8; 75%), followed by persistent glaucoma (2; 17%) and anterior uveitis (1; 8%). No other significant complication was seen during the follow-up period. Conclusion Plaque radiotherapy is a safe and effective conservative treatment option for IM, although cataract is a common, yet treatable, complication. This treatment scheme circumvents an intraocular procedure and may avoid the dissemination of malignant cells, and provides a margin of safety in the treatment of clinically undetectable disease. [source]

The treatment of uveal melanoma by ruthenium plaques

ACTA OPHTHALMOLOGICA, Issue 2009
B DAMATO
Purpose Plaque radiotherapy is the first choice of treatment for choroidal melanomas. The standard practice is to position the plaque centrically in relation to the tumour, with a 2mm physical safety margin in all directions. The author has developed techniques for administering brachytherapy with plaques positioned eccentrically, with their posterior edge aligned with the posterior tumour margin. This allows a higher apex dose to be given while reducing the radiation delivered to optic nerve and fovea. Methods The tumour is localized by transillumination and its anterior margin marked on the sclera with a pen. The 'plaque-tumour difference' measurement is then marked on the sclera at the point where the anterior plaque margin should be. A transparent plaque template is sutured to the sclera. The position of the plaque is checked with a right-angled fibre-optic transilluminator, which is passed through a perforation near the posterior edge of the template. If the template is positioned correctly, then with binocular indirect ophthalmoscopy one should see the 'sunset sign', which occurs when the transilluminator is exactly at the posterior tumour margin. Results Eccentric ruthenium plaque positioning has been practised in Liverpool for over a decade. The results have been published. Local tumour control rates have been good (partly because of case selection). Radiation maculopathy and optic neuropathy have been rare if the tumour has not extended within 1 mm of these structures. The main cause of visual loss has been maculopathy, caused by exudation from the irradiated tumour. Methods for treating such exudation are described. Conclusion Plaque radiotherapy is effective for choroidal melanomas up to 5 mm in thickness. It achieves good local tumour control with preservation of vision in most cases. [source]

3143: Management of iris melanomas with 125 iodine plaque radiotherapy

Management of uveal tumours

ACTA OPHTHALMOLOGICA, Issue 2009
B DAMATO
Purpose The purpose of this presentation is to describe the management of uveal melanomas and the other most common uveal tumours. Methods Choroidal melanomas are treated with plaque radiotherapy if possible, with proton beam radiotherapy, stereotactic radiotherapy, trans-scleral local resection, trans-retinal endoresection, phototherapy and enucleation being reserved for patients who cannot be managed with a plaque. Increasingly, tumour biopsy is performed for histological grading of malignancy and for cytogenetic studies aimed at determining the genomic tumour type so that risk of metastatic disease can be determined. Choroidal metastases usually respond to external beam radiotherapy. Biopsy may be needed to confirm the diagnosis. Choroidal haemangiomas are treated by photodynamic therapy, with good response in most patients. Results In the large majority of patients, it is possible to conserve the eye and vision. Patients need life-long follow-up in case tumour recurrence occurs. After radiotherapy of choroidal and ciliary body melanomas some patients develop exudative and neovascular complications needing treatment. Conclusion Successful management of uveal tumours is based on a firm diagnosis, accurate staging of disease, reliable prognostication and adequate aftercare. [source]

An audit of eccentrically-positioned ruthenium plaque radiotherapy of choroidal melanoma in Liverpool

ACTA OPHTHALMOLOGICA, Issue 2009
A RUSSO
Purpose Brachytherapy is usually administered with the plaque overlapping the entire tumour margin by at least 1-2mm. With posterior tumours, our practice is to position the plaque with its posterior edge aligned with the posterior tumour margin. We audited ocular outcomes after eccentrically-placed ruthenium plaque radiotherapy of choroidal melanoma. Methods Patients were included if receiving primary ruthenium brachytherapy for choroidal melanoma during the three years up to the 31st July 2007. A perforated template was used to facilitate plaque positioning. For posterior tumors, the template was positioned so that trans-illumination produced a glow at the posterior tumour margin (,sunset sign'). Minimum doses of 300-350 Gy and 80-90 Gy were prescribed to the sclera and apex, respectively. Results The cohort comprised 162 patients (93 female and 69 male). The time to the last known visual acuity had a median of 23 months. The initial visual acuity was 20/40 or better in 94.6%, 20/60 to 20/200 in 13.0% and worse than 20/200 in 1.9% of patients. The tumours had a mean basal diameter of 11.7mm. Ten tumours exceeded 5.4 mm in height. Tumour extension to within 5mm of optic disc, fovea or both occurred in 18 (11.1%), 28 (17.3%) and 27 (16.7%) cases respectively. Risk factors for visual loss were proximity to optic disc or fovea, initial visual acuity worse than 20/40 and tumour height exceeding 5.4 mm. In 66 patients with none of these risk factors, 92% retained 20/40 or better and 5 had vision of 20/60 , 20/200. In 72 with one risk factor, 74.3% retained 20/16 , 20/40 and 95.7% had vision of 20/200 or better. In 12 patients with 2 risk factors, these percentages were 25.0% and 91.7%. Only 3 patients had 3 risk factors and one retained vision of 20/200 or better. Tumours distanced < 5 mm to fovea were divided in 3 groups, and visual acuity analysed. Three patients had local tumour recurrence and were treated respectively by proton beam radiotherapy, plaque radiotherapy and enucleation (the only eye lost in this series). Conclusion Eccentric plaque radiotherapy of choroidal melanoma achieves good rates of local tumour control, ocular retention and preservation of vision. [source]

Non-contiguous recurrence or secondary choroidal melanoma following plaque radiotherapy

CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 7 2007
Mauricio Maia MD
Abstract Non-contiguous local recurrence of posterior uveal melanoma occurs rarely after plaque therapy. A 50-year-old white first presented with choroidal melanoma. He underwent therapy with episcleral iodine-125 radioactive plaque therapy. Nine years later fundus evaluation revealed a new pigmented lesion in the inferotemporal equatorial area. Patient was considered to have a non-contiguous recurrent melanoma and the eye was enucleated. Histologic microscopic examination disclosed a 3 × 1.8 mm densely pigmented tumour internal to the choroid at the equator. The tumour was composed of large round cells with round nuclei, prominent nucleoli, abundant cytoplasm and spindle-shaped cells with spindle-shaped nuclei and prominent nucleoli. The tumour extended through the retina. The superior nasal area of plaque therapy had extensive chorioretinal atrophy with loss of retinal pigment epithelium, thinning of the retina and thinning and depigmentation of the choroids. Within this area of atrophy, there was a pigmented lesion composed by densely packed, spindle-shaped cells with spindle-shaped nuclei. Our patient illustrated non-contiguous recurrence of choroidal melanoma, such finding raises concerns about physiopathology and treatment of choroidal melanoma. [source]