CyberKnife Robot-Assisted Radiosurgery for Ciliochoroidal Melanoma: Early Results in Mexico.

Abstract

Purpose :
To report the initial results of CyberKnife stereotactic body radiotherapy (SBRT) on patients with ciliochoroidal (CBCh) melanoma in our population.

Methods :
Cyberknife SBRT (Accuray, Sunnyvale, CA, USA) was offered as a therapeutic alternative to enucleation and ruthenium-106 brachytherapy. Inclusion criteria included: treatment naïve ciliochoroidal melanoma ≥9mm in initial height and Stage ≥T3. Exclusion criteria included ecographic evidence of extrascleral tumoral extension, neovascular glaucoma and systemic metastasis. Ocular akinesia was achieved with 2.5mL of 0.75% bupivacaine retrobulbar block on two surgical times. CT/MRI fusing was performed and target volumes and structures at risks were delineated. Cyberknife radiosurgery was performed delivering a single fraction with a mean dose of 25 Gy to the 70% isodose line. Local tumor control was defined as either shrinking of the tumor or absent progression.

Results : Five patients with CBCh melanoma were treated under this protocol. Mean age was 51.4 years (range 44 - 60 years), 40% were female. Mean tumor height before treatment was 11.07 ± 1.98 mm. Mean follow-up of patients was <12 months. Three patients had serous retinal detachment associated with the tumor at presentation. All of the patients had local tumor control after a single-session radiosurgery within the follow-up period. No acute toxicity was observed, and none of the patients required enucleation during this short follow-up time.

Conclusions :
A multidisciplinary approach with Cyberknife SBRT is an effective and safe therapy for medium to large-sized CBCh melanoma. Further follow-up periods are needed to confirm these findings and to evaluate long-term ophthalmic events.

This is a 2021 ARVO Annual Meeting abstract.

 

Before and After Cyberknife robotic-assisted radiosurgery. a) Initial height: 9.51 mm, b) After height 6.54 mm.