Radiation retinopathy (RR) and radiation maculopathy (RM) can occur as a result of uveal melanoma radiation treatment and after irradiation of other head and neck extraocular tumors, even with ...precise targeting techniques, such as stereotactic or proton beam radiotherapy. This review provides an overview of the current understanding of potential radiation damage to ocular tissues, and how recent developments in ophthalmic multimodal imaging techniques and treatment modalities have improved managing options. Several treatment strategies have been employed so far for the management of RR, including laser photocoagulation, intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents or glucocorticosteroids and surgery. The use of intravitreal anti-VEGFs or dexamethasone implants have significantly altered the final visual outcome for uveal melanoma patients. As a prophylaxis, a few different strategies were proposed, but still there is a lack of large randomized clinical trials supporting these approaches and clear clinical guidelines for daily practice. Early detection and proper treatment are crucial in preventing or reducing vision loss, and improving patients' quality of life. Close monitoring and timely intervention are essential for successful management.
To investigate the frequency and location of additional primary malignancies in a Polish cohort of uveal melanoma (UM) patients registered in a single centre database.
Retrospective data analysis of ...patients treated for uveal melanoma at the Department of Ophthalmology, Poznań University of Medical Sciences, Poland between 1991 and 2017. Data on the diagnosis of the additional malignancies were obtained during the follow-up visits in our Department and/or from the Greater Poland Cancer Registry. The exclusion criteria comprised no confirmed follow-up or incomplete clinical entry data.
Among 644 UM patients registered in the database up to 2017, the additional malignancy was diagnosed in 126 (20%) patients: 71 men, 55 women at the median age of 67 years (range: 34-94). In 48 patients (38%), the additional malignancy occurred prior to the diagnosis of UM, in 73 (58%) patients - after it. The most common locations of second cancer were skin (20 cases / 15%), breast (17 cases / 13%) and lungs (15 cases / 12%). The median follow-up was 36 months (range: 3-242). 87 patients (69%) died by the study close, 32 (37%) of them due to metastatic disease from uveal melanoma, 41 (47%) due to another cancer.
The frequency of additional primary malignancies was higher in our cohort than reported by most of other groups. If there is a certain predisposition to a specific type of additional primary carcinoma in UM patients, the analysis of larger database is required.
Ruthenium brachytherapy for iris melanoma Zwolińska, Emilia; Główka, Lidia; Chicheł, Adam ...
Journal of contemporary brachytherapy,
01/2023, Letnik:
15, Številka:
5
Journal Article
Recenzirano
Odprti dostop
PurposeThe study aimed to review the long-term outcomes of ruthenium brachytherapy for iris and iridociliary melanoma.Material And MethodsMedical records of patients who underwent ruthenium plaque ...treatment for iris and iridociliary melanoma at the Department of Ophthalmology, Poznań University of Medical Sciences, between 1999 and 2021 were retrospectively reviewed.ResultsWe identified 24 patients, including 17 women and 7 men, with a median age of 61.5 years (range, 35-84 years). Median observation time before treatment was 3 months (range, 0-68 months). Nineteen (79%) patients received a treatment with 20 mm CCB plaque, 5 (21%) with 15 mm CCA plaque and 2 (8%) patients received total irradiation to the entire iridocorneal angle. Median follow-up was 67.5 months (range, 24-265 months). We noted one (4%) recurrence managed by irradiating the anterior segment. Twelve (50%) patients developed post-operative cataracts in a median time of 38 months following treatment, 5 (21%) required topical medications to control intraocular pressure, and one (4%) developed chronic macular edema (CME) that was managed with anti-VEGF therapy. Final visual acuity between 1.0 and 0.5 was observed for 16 (67%) patients, between 0.49-0.1 for 5 (21%) patients, and below 0.09 for 3 (12%) patients. Nine (37%) patients maintained final visual acuity stable; in 4 (17%) patients, it dropped more than 3 lines, and improved in 6 (25%) patients.ConclusionsRuthenium brachytherapy with standard applicators is an effective and safe way of treatment for iris and iridociliary melanoma. We observed no significant post-operative complications in a long-term observation.
Uveal melanoma is the most common primary malignancy of the eye in adults. It may involve the choroid and ciliary body, and in only 2-3% of cases it involves the iris. We present a case of a ...56-year-old patient with a 6-year history of unilateral, inflammatory, refractory glaucoma of the right eye. Due to acquired heterochromia and heterogeneous thickness of the iris, iris melanoma was suspected, but the incisional biopsy did not confirm the diagnosis. In the next months, the lesion enlarged and the eye globe was enucleated. Histopathological examination revealed an iridociliary melanoma with annular growth pattern.
The role of the eyelids is to protect and moisturise the eye. Despite its small relative surface area, 5-10% of skin cancers originate in the eyelids.
To assess the prevalence of different types of ...skin lesions in the area of eyelids based on retrospective histopathology data from a tertiary centre.
Among 544 included eyelid lesions, 429 (79%) were benign and 115 (21%) were malignant. In the benign group, the most common finding was a chalazion (49.2%) followed by squamous papilloma (22.8%), seborrheic keratitis (10%), epidermal cyst (8.2%), and intradermal nevus (5.1%). Out of all malignant lesions, the most common diagnosis was basal cell carcinoma (BCC) in 110 (95.7%) patients.
Squamous cell carcinoma (SCC) was diagnosed in 3 (2.6%) patients and sebaceous gland carcinoma (SGC) in 2 (1.7%). No malignant melanoma was identified in the studied group.
Although benign lesions are the most common eyelid tumours, it is essential to differentiate between benign and malignant eyelid tumours because early detection and appropriate treatment may improve the cosmetic effect and reduce recurrences.
Aim: To present a case of neoadjuvant treatment of uveal melanoma with a limited core endoresection, which enabled ruthenium plaque radiotherapy to be administered. Material and Methods: A ...77-year-old woman presented in 2005 with a ciliochoroidal uveal melanoma measuring 7.2 by 6.5 mm basally with a thickness of 6.2 mm. The vision in the affected eye was 6/9. Because of diagnostic uncertainty, we performed a biopsy, which produced a copious sample. The biopsy serendipitously reduced the tumour thickness to 4.4 mm, making ruthenium plaque brachytherapy possible. Results: Histopathological examination showed the tumour to be a melanoma predominantly of spindle cell type. Postoperative complications included a dense vitreous haemorrhage, which cleared spontaneously, and raised intraocular pressure, controlled with latanoprost. Seven years after brachytherapy, the vision was 6/5 and the thickness of the residual tumour was 2.5 mm. Nine years after treatment, there was no evidence of any intra- or extraocular seeding or distant metastases. Conclusions: Core endoresection of a ciliochoroidal melanoma may reduce tumour thickness enough to allow subsequent ruthenium plaque radiotherapy.
The aim of this study was to report on results of uveal melanoma treatment with ruthenium-106 (
Ru) brachytherapy with long-term follow-up, in terms of local tumor control, eye retention rate, ...radiation retinopathy, and patients' survival.
Medical records of patients treated with ruthenium plaque due to uveal melanoma at the Department of Ophthalmology, Poznan University of Medical Sciences, Poland, between 1994 and 2014 were retrospectively reviewed.
We identified 126 patients: 53 men, 73 women, mean age 60.04 years (range, 21-89). The largest basal diameter ranged from 4.04 mm to 18.9 mm (median, 10.67 mm), tumor height was 1.9 mm to 7.42 mm (median, 4.8 mm). Median scleral radiation dose was 570 Gy (range, 235-1,500 Gy), median apical dose 100 Gy (range, 60-129 Gy). Median follow-up was 66.5 months (range, 2-261 months). We noted a total of 19 (15%) recurrences. The actuarial rate of recurrence was 9.5% at 3 years, and 13.5% at 5 years postoperatively. Nine (7%) eye globes were lost, median time to enucleation was 5 years. The eye retention rate at 5 years was 92.7% and 81% at 10 years. Forty-three (34%) patients died before the end of the study, 24 (19%) of them due to metastatic disease. Metastatic death was related to: tumor size and TNM stage at presentation (
= 0.002 vs.
= 0.0006, respectively) but not to age, gender, and plaque dosimetry.
Ru brachytherapy is an effective, globe sparing treatment that provides good tumor control and a high rate of survival. However, some ocular complications tend to appear late post-treatment, and therefore long-term follow-up is advised.
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