April 2010
Volume 51, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2010
Cyberknife Radiosurgery in the Therapy of Uveal Melanoma
Author Affiliations & Notes
  • M. M. Nentwich
    Department of Ophthalmology, Ludwig-Maximilian University, Munich, Germany
  • A. Muacevic
    European Cyberknife Center, Munich, Germany
  • A. Klingenstein
    Department of Ophthalmology, Ludwig-Maximilian University, Munich, Germany
  • B. Wowra
    European Cyberknife Center, Munich, Germany
  • A. Kampik
    Department of Ophthalmology, Ludwig-Maximilian University, Munich, Germany
  • U. C. Schaller
    Department of Ophthalmology, Ludwig-Maximilian University, Munich, Germany
  • Footnotes
    Commercial Relationships  M.M. Nentwich, None; A. Muacevic, R, R; A. Klingenstein, None; B. Wowra, R, R; A. Kampik, None; U.C. Schaller, None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 5139. doi:
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      M. M. Nentwich, A. Muacevic, A. Klingenstein, B. Wowra, A. Kampik, U. C. Schaller; Cyberknife Radiosurgery in the Therapy of Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5139.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Evaluation of the effectiveness and safety of framelss Cyberknife radiosurgery, which allows treating uveal melanoma within three hours in a single session under retrobulbar anaesthesia.

Methods: : Sixty-five (39 male, 26 female) with medium (prominence 3.1-8mm) and lage-sized (prominence > 8mm) unilateral uveal melanomas were treated with a frameless radiosurgery system. Median age was 67 years (range 28-94 years). All patients were treated in a single session consisting of retrobulbar anaesthesia, CT-scanning for the generation of a treatment plan and devlivery of a radiosurgical tumor dose between 18 and 23 Gy to the 70% isodose-line. Three dimensional planning aimed at sparing the lens and optic disc as much as possible. All patients are followed-up at regular intervals (3, 6 ,12 and 18 months after radiosurgery) consisting of clinical examination, ultrasound and CT-scanning.

Results: : All patients could be treated in a frameless setup using retrobulbar anestheasia within three hours. In patients with lateral and dorsal uveal melanomas the dose to the lens could be kept below 2 Gy. The clinical response was evaluated for the first 39 patients (26 male, 13 female) where the follow-up was at least 6 months. During the follow-up (range 6-37 months, Median 14 months) local tumor control of the irradiated lesion was achieved in 37/39 patients. One patient with a very large tumor (thickness 9.8mm, base: 11.6x16.5) and one patient with a parapapillar tumor location had to be enucleated during the follow-up period due to tumor growth. Using standardized ultrasound the median maximum apical tumor height regressed from 6 mm (Quartiles: 4.2 mm; 7,9 mm) to 4 mm (3.3 mm; 7.1 mm) (p<0.01). Median reflectivity increased from 52% (45%; 61%) to 64% (57%; 71%) during follow-up (p<0.01). No patient suffered from treatment-related complications such as neovascular glaucoma necessitating the enucleation of the eye.

Conclusions: : Cyberknife radiosurgery is an effective and safe therapeutic option with high patient comfort for the treatment of uveal melanoma. A longer follow-up and analysis of a larger patients group is necessary in order for definite assessment.

Keywords: tumors • radiation therapy • melanoma 
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