DOI: https://doi.org/10.22263/2312-4156.2023.1.83
I.Y. Zherka, P.D. Dziameshka, L.V. Naumenko, V.A. Hizemava
Radiation therapy of choroidal melanoma: comparative evaluation of the treatment results
N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Republic of Belarus
Vestnik VGMU. 2023;22(1):83-93.
Abstract.
Objectives. To conduct a systematic review of the application results of various methods of radiation therapy for choroidal melanoma treatment, as well as to compare the results of stereotactic radiosurgery and brachytherapy application for the choroidal melanoma treatment in a monocenter study.
Material and methods. As a part of systematic review, publications for analysis were searched for in the PubMed database using the queries “Brachytherapy and uveal melanoma or choroid melanoma”, “Proton therapy and uveal melanoma or choroid melanoma”, “Stereotactic radiosurgery and uveal melanoma or choroid melanoma” over the past 5 years. The review included 38 publications. The monocentric clinical study of prospective stereotactic radiosurgery group included 61 patients who were diagnosed with choroidal melanoma cT1-4N0M0. The historical control group consisted of patients with comparable tumor size who underwent brachytherapy (55 patients). Comparative analysis of local control levels, overall survival, progression-free survival, and complication rate was made.
Results. Two-year disease-free survival in the stereotactic radiosurgery group was 95.2±4.6%, in the brachytherapy group it made up 63.9±6.1% (p log-rank = 0.001). Complications in the stereotactic radiosurgery group were registered in 33 (44.0%) cases, in the brachytherapy group – in 14 (22.9%) cases (p=0.027). The level of eyeball preservation within two years after treatment was 84.0±6.1% and 82.0±4.9% after stereotactic radiosurgery and brachytherapy, respectively (p log-rank=0.93).
Conclusions. The results of the stereotactic radiosurgery application for the treatment of choroidal melanoma are not inferior in terms of efficacy and safety to brachytherapy.
Keywords: choroidal melanoma, stereotactic radiosurgery, brachytherapy, radiation therapy, disease-free survival.
References
1. Toktas ZO, Bicer A, Demirci G, Pazarli H, Abacioglu U, Peker S, et al. Gamma knife stereotactic radiosurgery yields good long-term outcomes for low-volume uveal melanomas without intraocular complications. J Clin Neurosci. 2010 Apr;17(4):441-5. doi: http://dx.doi.org/10.1016/j.jocn.2009.08.004
2. Kang DW, Lee SC, Park YG, Chang JH. Long-term results of Gamma Knife surgery for uveal melanomas. J Neurosurg. 2012 Dec;117 Suppl:108-14. doi: http://dx.doi.org/10.3171/2012.8.GKS121002
3. Grossniklaus HE, Eberhart CG, Kivela TT, editors (2018). WHO classification of tumours of the eye. 4th ed. Lyon: IARC. Vol. 12.
4. Damato, B. Progress in the management of patients with uveal melanoma. The 2012 Ashton Lecture. Eye (Lond). 2012 Sep;26(9):1157-72. doi: http://dx.doi.org/10.1038/eye.2012.126
5. Shields JA, Shields CL. Management of posterior uveal melanoma: past, present, and future: the 2014 Charles L. Schepens Lecture. Ophthalmology. 2015 Feb;122(2):414-28. doi: http://dx.doi.org/10.1016/j.ophtha.2014.08.046
6. Gündüz K, Shields CL, Shields JA, Cater J, Brady L. Plaque radiotherapy for management of ciliary body and choroidal melanoma with extraocular extension. Am J Ophthalmol. 2000 Jul;130(1):97-102. doi: http://dx.doi.org/10.1016/s0002-9394(00)00385-8
7. Lommatzsch P, Vollmar R. A new way in the conservative therapy of intraocular tumors by means of beta-irradiation (ruthenium 106) with preservation of vision [German]. Klin Monbl Augenheilkd. 1966;148(5):682-99.
8. Shields CL, Shields JA, Cater J, Gündüz K, Miyamoto C, Micaily B, et al. Plaque radiotherapy for uveal melanoma: long-term visual outcome in 1106 consecutive patients. Arch Ophthalmol. 2000 Sep;118(9):1219-28. doi: http://dx.doi.org/10.1001/archopht.118.9.1219
9. Melia BM, Abramson DH, Albert DM, Boldt HC, Earle JD, Hanson WF, et al. Collaborative ocular melanoma study (COMS) randomized trial of I-125 brachytherapy for medium choroidal melanoma. I. Visual acuity after 3 years COMS report no. 16. Ophthalmology. 2001 Feb;108(2):348-66. doi: http://dx.doi.org/10.1016/s0161-6420(00)00526-1
10. Damato B, Kacperek A, Chopra M, Sheen MA, Campbell IR, Errington RD. Proton beam radiotherapy of iris melanoma. Int J Radiat Oncol Biol Phys. 2005 Sep;63(1):109-15. doi: http://dx.doi.org/10.1016/j.ijrobp.2005.01.050
11. Akbaba S, Foerster R, Nicolay NH, Arians N, Bostel T, Debus J, et al. Linear accelerator-based stereotactic fractionated photon radiotherapy as an eye-conserving treatment for uveal melanoma. Radiat Oncol. 2018;140:13. doi: http://dx.doi.org/10.1186/s13014-018-1088-9
12. Zherko IYu, Demeshko PD, Naumenko LV, Minaylo II, Zhilyaeva EP, Gizemova OA, i dr. Immediate results of choroidal melanoma treatment using stereotactic radiosurgery. Luchevaya Diagnostika Terapiya. 2022;13(1):95-102. (In Russ.)
13. Zherko IYu, Demeshko PD, Naumenko LV, Zhilyaeva EP, Gizemova OA, Polyakov SL. Prognostic factors for secondary glaucoma after stereotactic radiosurgery for choroidal melanoma. Zhurn GrGMU. 2022;20(3):335-42. (In Russ.)
14. Chang M, Dalvin LA, Mazloumi M, Martin A, Yaghy A, Yang X, et al. Prophylactic intravitreal bevacizumab after plaque radiotherapy for uveal melanoma: Analysis of visual acuity, tumor response, and radiation complications in 1131 eyes based on patient age. Asia Pac J Ophthalmol (Phila). 2020 Jan-Feb;9(1):29-38. doi: http://dx.doi.org/10.1097/APO.0000000000000271
15. Espensen CA, Appelt AL, Fog LS, Gothelf AB, Thariat J, Kiilgaard JF. Predicting visual acuity deterioration and radiation-induced toxicities after brachytherapy for choroidal melanomas. Cancers (Basel). 2019 Aug 6;11(8):1124. doi: http://dx.doi.org/10.3390/cancers11081124
16. Espensen CA, Appelt AL, Fog LS, Thariat J, Gothelf AB, Aznar MC, et al. Tumour control probability after ruthenium-106 brachytherapy for choroidal melanomas. Acta Oncol. 2020 Aug;59(8):918-25. doi: http://dx.doi.org/10.1080/0284186X.2020.1762925
17. Filì M, Trocme E, Bergman L, Ong See TR, André H, Bartuma K, et al. Ruthenium-106 versus iodine-125 plaque brachytherapy of 571 choroidal melanomas with a thickness of >/=5.5 mm. Br J Ophthalmol. 2020 Jan;104(1):26-32. doi: http://dx.doi.org/10.1136/bjophthalmol-2018-313419
18. Ghassemi F, Sheibani S, Arjmand M, Poorbaygi H, Kouhestani E, Sabour S, et al. Comparison of iodide-125 and ruthenium-106 brachytherapy in the treatment of choroidal melanomas. Clin Ophthalmol. 2020 Feb;14:339-46. doi: http://dx.doi.org/10.2147/OPTH.S235265
19. Jouhi S, Heikkonen J, Reijonen V, Raivio V, Täll M, Kivelä TT. Brachytherapy of choroidal melanomas less than 10 mm in largest basal diameter: Comparison of 10-mm and 15-mm ruthenium plaques. Ophthalmology. 2021 Jan;128(1):140-51. doi: http://dx.doi.org/10.1016/j.ophtha.2020.06.057
20. Stalhammar G. Forty-year prognosis after plaque brachytherapy of uveal melanoma. Sci Rep. 2020 Jul;10(1):11297. doi: http://dx.doi.org/10.1038/s41598-020-68232-7
21. Yupari RJ, Bena J, Wilkinson A, Suh J, Singh A. Small choroidal melanoma: Outcomes following apical height dose brachytherapy. Br J Ophthalmol. 2021 Aug;105(8):1161-5. doi: http://dx.doi.org/10.1136/bjophthalmol-2020-316873
22. King BA, Awh C, Gao BT, Wang J, Kocak M, Morales-Tirado VM, et al. Iodine-125 episcleral plaque brachytherapy for ajcc t4 posterior uveal melanoma: Clinical outcomes in 158 patients. Ocul Oncol Pathol. 2019 Aug;5(5):340-349. doi: http://dx.doi.org/10.1159/000495249
23. Kowal J, Markiewicz A, Dębicka-Kumela M, Bogdali A, Jakubowska B, Karska-Basta I, et al. Analysis of local recurrence causes in uveal melanoma patients treated with (125)i brachytherapy - a single institution study. J Contemp Brachytherapy. 2019 Dec;11(6):554-62. doi: http://dx.doi.org/10.5114/jcb.2019.90985
24. Kowal J, Markiewicz A, Dębicka-Kumela M, Bogdali A, Romanowska-Dixon BE. Outcomes of I-125 brachytherapy for uveal melanomas depending on irradiation dose applied to the tumor apex - a single institution study. J Contemp Brachytherapy. 2018 Dec;10(6):532-41. doi: http://dx.doi.org/10.5114/jcb.2018.79886
25. Danish H, Ferris MJ, Balagamwala E, Switchenko JM, Patel KR, Choudhary M, et al. Comparative outcomes and toxicities for ruthenium-106 versus palladium-103 in the treatment of choroidal melanoma. Melanoma Res. 2018 Apr;28(2):120-5. doi: http://dx.doi.org/10.1097/CMR.0000000000000420
26. AlMahmoud T, Quinlan-Davidson S, Pond GR, Deschênes J. Outcome Analysis of Visual Acuity and Side Effect after Ruthenium-106 Plaque Brachytherapy for Medium-sized Choroidal Melanoma. Middle East Afr J Ophthalmol. 2018 Apr-Jun;25(2):103-7. doi: http://dx.doi.org/10.4103/meajo.MEAJO_198_16
27. A Le BH, Kim JW, Deng H, Rayess N, Jennelle RL, Zhou SY, et al. Outcomes of choroidal melanomas treated with eye physics plaques: A 25-year review. Brachytherapy. 2018 Nov-Dec;17(6):981-9. doi: http://dx.doi.org/10.1016/j.brachy.2018.07.002
28. Maheshwari A, Finger PT. A 12-year study of slotted palladium-103 plaque radiation therapy for choroidal melanoma: near, touching, or surrounding the optic nerve. Am J Ophthalmol. 2018 Apr;188:60-9. doi: http://dx.doi.org/10.1016/j.ajo.2018.01.025
29. Maheshwari A, Finger PT. Regression patterns of choroidal melanoma: After palladium-103 ((103)pd) plaque brachytherapy. Eur J Ophthalmol. 2018 Nov;28(6):722-30. doi: http://dx.doi.org/10.1177/1120672118776146
30. Shields CL, Sioufi K, Srinivasan A, Di Nicola M, Masoomian B, Barna LE, et al. Visual outcome and millimeter incremental risk of metastasis in 1780 patients with small choroidal melanoma managed by plaque radiotherapy. JAMA Ophthalmol. 2018 Dec;136(12):1325-33. doi: http://dx.doi.org/10.1001/jamaophthalmol.2018.3881
31. Bellerive C, Aziz HA, Bena J, Wilkinson A, Suh JH, Plesec T, et al. Local failure after episcleral brachytherapy for posterior uveal melanoma: Patterns, risk factors, and management. Am J Ophthalmol. 2017 May;177:9-16. doi: http://dx.doi.org/10.1016/j.ajo.2017.01.024
32. Hegde JV, McCannel TA, McCannel CA, Lamb J, Wang P-C, Veruttipong D, et al. Juxtapapillary and circumpapillary choroidal melanoma: Globe-sparing treatment outcomes with iodine-125 notched plaque brachytherapy. Graefes Arch Clin Exp Ophthalmol. 2017 Sep;255(9):1843-50. doi: http://dx.doi.org/10.1007/s00417-017-3703-0
33. Oellers P, Mowery YM, Perez BA, Stinnett S, Mettu P, Vajzovic L, et al. Efficacy and safety of low-dose iodine plaque brachytherapy for juxtapapillary choroidal melanoma. Am J Ophthalmol. 2018 Feb;186:32-40. doi: http://dx.doi.org/10.1016/j.ajo.2017.11.008
34. Patel KR, Prabhu RS, Switchenko JM, Chowdhary M, Craven C, Mendoza P, et al. Visual acuity, oncologic, and toxicity outcomes with (103)pd vs. (125)i plaque treatment for choroidal melanoma. Brachytherapy. 2017 May-Jun;16(3):646-53. doi: http://dx.doi.org/10.1016/j.brachy.2017.01.012
35. Rospond-Kubiak I, Wróblewska-Zierhoffer M, Twardosz-Pawlik H, Kocięcki J. Ruthenium brachytherapy for uveal melanoma - single institution experience. J Contemp Brachytherapy. 2017 Dec;9(6):548-52. doi: http://dx.doi.org/10.5114/jcb.2017.72606
36. Sánchez-Tabernero S, García-Alvarez C, Muñoz-Moreno MF, Diezhandino P, Alonso-Martínez P, de Frutos-Baraja JM, et al. Pattern of local recurrence after I-125 episcleral brachytherapy for uveal melanoma in a spanish referral ocular oncology unit. Am J Ophthalmol. 2017 Aug;180:39-45. doi: http://dx.doi.org/10.1016/j.ajo.2017.05.019
37. Tagliaferri L, Pagliara MM, Masciocchi C, Scupola A, Azario L, Grimaldi G, et al. Nomogram for predicting radiation maculopathy in patients treated with ruthenium-106 plaque brachytherapy for uveal melanoma. J Contemp Brachytherapy. 2017 Dec;9(6):540-7. doi: http://dx.doi.org/10.5114/jcb.2017.71795
38. Levy RP, Schulte RWM. Stereotactic radiosurgery with charged-particle beams: technique and clinical experience. Transl Cancer Res 2012 Oct;1(3):159-72. doi: http://dx.doi.org/10.3978/j. issn.2218-676X.2012.10.04
39. Mishra KK, Quivey JM, Daftari IK, Weinberg V, Cole TB, Patel K, et al. Long-term results of the UCSF-LBNL randomized trial: charged particle with helium ion versus iodine-125 plaque therapy for choroidal and ciliary body melanoma. Int J Radiat Oncol Biol Phys. 2015 Jun;92(2):376-83. doi: http://dx.doi.org/10.1016/j.ijrobp.2015.01.029
40. Marinkovic M, Pors LJ, van den Berg V, Peters FP, Schalenbourg A, Zografos L, et al. Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy. Cancers (Basel). 2021 Dec;13(24):6241. doi: http://dx.doi.org/10.3390/cancers13246241
41. Bolling JP, Dagan R, Rutenberg M, Mamalui-Hunter M, Buskirk SJ, Heckman MG, et al. Treatment of Uveal Melanoma With Radioactive Iodine 125 Implant Compared With Proton Beam Radiotherapy. Mayo Clin Proc Innov Qual Outcomes. 2021 Dec;6(1):27-36. doi: http://dx.doi.org/10.1016/j.mayocpiqo.2021.10.002
42. Oxenreiter MM, Lane AM, Aronow MB, Shih H, Trofimov AV, Kim IK, et al. Proton beam irradiation of uveal melanoma involving the iris, ciliary body and anterior choroid without surgical localisation (light field). Br J Ophthalmol. 2022 Apr;106(4):518-21. doi: http://dx.doi.org/10.1136/bjophthalmol-2020-318063
43. Modorati GM, Dagan R, Mikkelsen LH, Andreasen S, Ferlito A, Bandello F. Gamma Knife Radiosurgery for Uveal Melanoma: A Retrospective Review of Clinical Complications in a Tertiary Referral Center. Ocul Oncol Pathol. 2020 Mar;6(2):115-22. doi: http://dx.doi.org/10.1159/000501971
44. Papakostas TD, Lane AM, Morrison M, Gragoudas ES, Kim IK. Long-term Outcomes After Proton Beam Irradiation in Patients With Large Choroidal Melanomas. JAMA Ophthalmol. 2017 Nov;135(11):1191-6. doi: http://dx.doi.org/10.1001/jamaophthalmol.2017.3805
45. Furdova A, Babal P, Kobzova D, Zahorjanova P, Kapitanova K, Sramka M, et al. Uveal melanoma survival rates after single dose stereotactic radiosurgery. Neoplasma. 2018 Nov;65(6):965-71. doi: http://dx.doi.org/10.4149/neo_2018_171209N808
46. Laliscia C, Genovesi-Ebert F, Perrone F, Guido F, Cresti F, Fuentes T, et al. Photon-based High-dose Single-fraction Radiosurgery, an Effective Treatment Modality for Large and Posterior Uveal Melanoma. Anticancer Res. 2022 Apr;42(4):1965-72. doi: http://dx.doi.org/10.21873/anticanres.15674
47. Cicinelli MV, Di Nicola M, Gigliotti CR, Battista M, Miserocchi E, Del Vecchio A, et al. Predictive factors of radio-induced complications in 194 eyes undergoing gamma knife radiosurgery for uveal melanoma. Acta Ophthalmol. 2021 Dec;99(8):e1458-66. doi: http://dx.doi.org/10.1111/aos.14814
48. Collaborative Ocular Melanoma Study Group. The coms randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: Coms report no. 28. Arch Ophthalmol. 2006 Dec;124(12):1684-93. doi: http://dx.doi.org/10.1001/archopht.124.12.1684
49. Miguel D, de Frutos-Baraja JM, López-Lara F, Saornil MA, García-Álvarez C, Alonso P, et al. Radiobiological doses, tumor, and treatment features influence on local control, enucleation rates, and survival after epiescleral brachytherapy. A 20-year retrospective analysis from a single-institution: Part i. J Contemp Brachytherapy. 2018 Aug;10(4):337-46. doi: http://dx.doi.org/10.5114/jcb.2018.77849
50. Krantz BA, Dave N, Komatsubara KM, Marr BP, Carvajal RD. Uveal melanoma: epidemiology, etiology, and treatment of primary disease. Clin Ophthalmol. 2017 Jan;11:279-89. doi: http://dx.doi.org/10.2147/OPTH.S89591
51. Parker T, Rigney G, Kallos J, Stefko ST, Kano H, Niranjan A, et al. Gamma knife radiosurgery for uveal melanomas and metastases: a systematic review and meta-analysis. Lancet Oncol. 2020 Nov;21(11):1526-36. doi: http://dx.doi.org/10.1016/S1470-2045(20)30459-9
52. Bentzen SM. Preventing or reducing late side effects of radiation therapy: radiobiology meets molecular pathology. Nat Rev Cancer. 2006 Sep;6(9):702-13. doi: http://dx.doi.org/10.1038/nrc1950
53. Osman IM, Abouzeid H, Balmer A, Gaillard MC, Othenin-Girard P, Pica A, et al. Modern cataract surgery for radiation-induced cataracts in retinoblastoma. Br J Ophthalmol. 2011 Feb;95(2):227-30. doi: http://dx.doi.org/10.1136/bjo.2009.173401
54. Gigliotti CR, Modorati G, Di Nicola M, Fiorino C, Perna LA, Miserocchi E, et al. Predictors of radio-induced visual impairment after radiosurgery for uveal melanoma. Br J Ophthalmol. 2018 Jun;102(6):833-9. doi: http://dx.doi.org/10.1136/bjophthalmol-2017-310801
Information about authors:
I.Y. Zherka – associate research officer of the laboratory of oncopathology of the head and neck with a group of oncopathology of the central nervous system, N.N. Alexandrov National Cancer Centre of Belarus, https://orcid.org/0000-0002-5134-3666
e-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Iryna Y. Zherka;
P.D. Dziameshka – Doctor of Medical Sciences, associate professor, principal research officer of the radiation therapy laboratory, N.N. Alexandrov National Cancer Centre of Belarus, https://orcid.org/0000-0002-1324-3656
L.V. Naumenko – Candidate of Medical Sciences, leading research officer of the laboratory of oncopathology of the head and neck with a group of oncopathology of the central nervous system, N.N. Alexandrov National Cancer Centre of Belarus;
V.A. Hizemava – radiation oncologist, N.N. Alexandrov National Cancer Centre of Belarus.
