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Maria Vittoria Cicinelli, Marco Battista, Maura Di Nicola, Alessandro Marchese, Chiara Giuffré, Elisabetta Miserocchi, Francesco Bandello, Giulio Modorati; Gamma Knife for uveal melanoma: clinical and treatment predictors for radio-induced complications. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3616.
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Gamma knife radiosurgery (GKR) has shown promising results in the treatment of uveal melanoma (UM) in terms of local tumor control. GKR is not free from sight-threatening side-effects, including cataract, radiation retinopathy (RR), radiation maculopathy (RM), and radiation papillopathy (RP). Primary aim is to report rate and risk factors of treatment-induced complications in UM patients undergoing GKR.
Single-center, retrospective study, including patients with UM treated at the Ocular Oncology Service, San Raffaele Scientific Institute, Milan from September 1993 to April 2019. Clinical charts comprised complete ophthalmological examination with measurement of best-corrected visual acuity (BCVA), slit-lamp biomicroscopy, indirect ophthalmoscopy at each visit. B-scan ultrasound (Aviso S; Paris, France), optical coherence tomography (Heidelberg Spectralis; Heidelberg, Germany), retinography, and fundus fluorescein angiography (standard or ultra-widefield (California; Optos, Dunfermline, Scotland, UK)) were performed.Variables associated with each GKR-related complication were investigated using univariate and multivariate Cox proportional hazard regression models.
193 patients (99 males, 51.3%) included. Median age at the time of treatment was 65 years (27-89), all participants were Caucasian. In 183 eyes (95%) the tumor was primarily located at the choroid. The median follow-up was 60.93 months (6-286); radiation-induced complications were found in 152 eyes (79%). The presence of exudative RD at baseline was significant prognostic factor for 2-lines vision loss (HR 1.58, 95%CI= 1.01-2.49). Older age (HR 0.50, 95%CI= 0.29-0.84 p=0.009), thickness >6.09 mm (HR 0.48, 95%CI= 0.29-0.8, p=0.005) and mid-periphery location of the tumor (HR 0.5, 95%CI= 0.31-0.874 p=0.008) were protective factor for development of RR. Thickness >6.09 mm (HR 0.45, 95%CI= 0.27-0.76, p=0.002), periphery location of the tumor (HR 0.49, 95%CI= 0.30-0.78, p=0.003), Bruch’s membrane rupture (HR 0.34, 95%CI= 0.18-0.64, p=0.001) were protective factors for RP. Risk of RM was influenced by temporal site of the tumor (HR 4.27, 95%CI= 0.93-19.52).
Understanding of risk factor for GKR complications might help for better counseling and treatment planning in UM patients
This is a 2020 ARVO Annual Meeting abstract.
Spectrum of posterior segment complications after GKR.
Kaplan-Meier plots of probability of radiation-induced complications after GKR
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