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P.R. Golchet, I.K. Daftari, S. Lin, V. Weinberg, J.M. O'Brien; Intra-operative Ultrasound Biomicroscopy in Proton Irradiation of Anterior Uveal Melanoma . Invest. Ophthalmol. Vis. Sci. 2003;44(13):3611.
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Purpose: To evaluate the clinical utility of intra-operative ultrasound biomicroscopy (UBM) in localizing tantulum marker rings relative to anterior uveal melanoma tumor margins for subsequent proton beam irradiation. Methods: Sixteen eyes in 16 patients with anterior uveal melanoma were evaluated. Intra-operative UBM was performed prior to proton beam irradiation planning. The distance between tantulum marker rings and tumor margins was measured by transillumination and by indirect ophthalmoscopy with a trans-scleral point light source. Suture placement relative to tumor margins was then evaluated by UBM. Proton beam irradiation planning was undertaken with UBM data (treatment plan 1) and without UBM data (treatment plan 2). One-way analysis of variance and nonparametric methods were used to compare distributions for paired data using the Wilcoxon matched pairs test and for non-paired data using either the Mann-Whitney or Kruskal-Wallis test. Results: Sixteen eyes had a total of 50 tantulum marker rings placed. There was an average of 0.62 mm (0.36 - 0.89 95% CI) difference between treatment planning with UBM compared to traditional treatment planning (p = .0002), indicating a greater distance detected with the addition of UBM. Optimal tantulum ring localization with the aid of intra-operative UBM allows for reduction in tumor margins so as to minimize irradiation of tumor-free structures. There was no correlation between differences in treatment plans and patient age, tumor size, number of clips used per patient. Conclusions: Intra-operative ultrasound biomicroscopy is useful in precisely localizing tantulum markers with respect to tumor margins to facilitate subsequent proton beam radiation planning.
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