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Title: Precision, high dose radiotherapy: helium ion treatment of uveal melanoma

Abstract

The authors report on 75 patients with uveal melanoma who were treated by placing the Bragg peak of a helium ion beam over the tumor volume. The technique localizes the high dose region very tightly around the tumor volume. This allows critical structures, such as the optic disc and the macula, to be excluded from the high dose region as long as they are 3 to 4 mm away from the edge of the tumor. Careful attention to tumor localization, treatment planning, patient immobilization and treatment verification is required. With a mean follow-up of 22 months (3 to 60 months) the authors have had only five patients with a local recurrence, all of whom were salvaged with another treatment. Pretreatment visual acuity has generally been preserved as long as the tumor edge is at least 4 mm away from the macula and optic disc. The only serious complication to date has been an 18% incidence of neovascular glaucoma in the patients treated at our highest dose level. Clinical results and details of the technique are presented to illustrate potential clinical precision in administering high dose radiotherapy with charged particles such as helium ions or protons.

Authors:
; ; ; ; ; ; ; ; ;
Publication Date:
Research Org.:
Univ. of California, San Francisco
OSTI Identifier:
5606193
Report Number(s):
CONF-8310342-
Journal ID: CODEN: IOBPD; TRN: 85-015626
DOE Contract Number:
AC03-76SF00098
Resource Type:
Conference
Resource Relation:
Journal Name: Int. J. Radiat. Oncol., Biol. Phys.; (United States); Journal Volume: 11:2; Conference: 25. annual meeting of the American Society of Therapeutic Radiologists, Los Angeles, CA, USA, 3 Oct 1983
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; 62 RADIOLOGY AND NUCLEAR MEDICINE; EYES; BIOLOGICAL RADIATION EFFECTS; MELANOMAS; RADIOTHERAPY; SIDE EFFECTS; SENSE ORGANS DISEASES; RADIOINDUCTION; HELIUM; ION BEAMS; PATIENTS; SENSE ORGANS; UVEA; BEAMS; BIOLOGICAL EFFECTS; BODY; BODY AREAS; DISEASES; ELEMENTS; FACE; FLUIDS; GASES; HEAD; MEDICINE; NEOPLASMS; NONMETALS; NUCLEAR MEDICINE; ORGANS; RADIATION EFFECTS; RADIOLOGY; RARE GASES; THERAPY; 560151* - Radiation Effects on Animals- Man; 550603 - Medicine- External Radiation in Therapy- (1980-)

Citation Formats

Saunders, W.M., Char, D.H., Quivey, J.M., Castro, J.R., Chen, G.T.Y., Collier, J.M., Cartigny, A., Blakely, E.A., Lyman, J.T., and Zink, S.R. Precision, high dose radiotherapy: helium ion treatment of uveal melanoma. United States: N. p., 1985. Web.
Saunders, W.M., Char, D.H., Quivey, J.M., Castro, J.R., Chen, G.T.Y., Collier, J.M., Cartigny, A., Blakely, E.A., Lyman, J.T., & Zink, S.R. Precision, high dose radiotherapy: helium ion treatment of uveal melanoma. United States.
Saunders, W.M., Char, D.H., Quivey, J.M., Castro, J.R., Chen, G.T.Y., Collier, J.M., Cartigny, A., Blakely, E.A., Lyman, J.T., and Zink, S.R. 1985. "Precision, high dose radiotherapy: helium ion treatment of uveal melanoma". United States. doi:.
@article{osti_5606193,
title = {Precision, high dose radiotherapy: helium ion treatment of uveal melanoma},
author = {Saunders, W.M. and Char, D.H. and Quivey, J.M. and Castro, J.R. and Chen, G.T.Y. and Collier, J.M. and Cartigny, A. and Blakely, E.A. and Lyman, J.T. and Zink, S.R.},
abstractNote = {The authors report on 75 patients with uveal melanoma who were treated by placing the Bragg peak of a helium ion beam over the tumor volume. The technique localizes the high dose region very tightly around the tumor volume. This allows critical structures, such as the optic disc and the macula, to be excluded from the high dose region as long as they are 3 to 4 mm away from the edge of the tumor. Careful attention to tumor localization, treatment planning, patient immobilization and treatment verification is required. With a mean follow-up of 22 months (3 to 60 months) the authors have had only five patients with a local recurrence, all of whom were salvaged with another treatment. Pretreatment visual acuity has generally been preserved as long as the tumor edge is at least 4 mm away from the macula and optic disc. The only serious complication to date has been an 18% incidence of neovascular glaucoma in the patients treated at our highest dose level. Clinical results and details of the technique are presented to illustrate potential clinical precision in administering high dose radiotherapy with charged particles such as helium ions or protons.},
doi = {},
journal = {Int. J. Radiat. Oncol., Biol. Phys.; (United States)},
number = ,
volume = 11:2,
place = {United States},
year = 1985,
month = 2
}

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  • Survival rates and visual acuity of 100 patients treated for posterior uveal malignant melanoma by cobalt-60 plaque radiotherapy were compared with 150 patients treated by enucleation for the same disease. Life-table comparisons of the entire group showed significant differences in survival rates, with plaque radiotherapy patients appearing to fare better. However, when patients with small or medium tumors were compared, only slight differences were seen, implying that criteria used to select patients for treatment may affect interpretation. The two groups were also compared using the Cox proportional hazards model, which predicts survival based on the impact of clinical variables. Inmore » this analysis, the survival rates of the plaque radiotherapy group were no worse than those of the enucleation group. The advantage of conservative therapy lies in the potential to preserve useful vision over a considerable time.« less
  • In this paper, the authors present a technique for treating relatively small, low grade tumors located very close to critical, radiation sensitive central nervous system structures such as the spinal cord and the brain stem. A beam of helium ions is used to irradiate the tumor. The nearby normal tissues are protected by exploiting the superb dose localization properties of this beam, particularly its well defined and controllable range in tissue, the increased dose deposited near the end of this range (i.e., the Bragg peak), the sharp decrease in dose beyond the Bragg peak, and the sharp penumbra of themore » beam. To illustrate the technique, the authors present a group of 19 patients treated for chordomas, meningiomas and low grade chondrosarcomas in the base of the skull or spinal column. They have been able to deliver high, uniform doses to the target volumes, while keeping the doses to the nearby critical tissues below the threshold for radiation damage. Follow-up on this group of patients is short, averaging 22 months (2 to 75 months). Currently, 15 patients have local control of their tumor. Two major complications, a spinal cord transsection and optic tract damage, are discussed in detail. Their treatment policies have been modified to minimize the risk of these complications in the future, and they are continuing to use this method to treat such patients.« less
  • The reactivity of 33 choroidal and ciliary body melanomas with monoclonal antibody Ki-67, which recognizes a proliferation associated nuclear antigen, has been assessed and compared with clinicopathologic parameters. In 23 cases, 8 Gy irradiation was given 2 days before enucleation. Nonirradiated melanomas had a significantly higher proliferation rate as defined by staining with monoclonal antibody Ki-67 as compared with irradiated tumors (P = 0.007). Similarly, a strong relationship was found between pre-enucleation irradiation and low mitotic activity (P = 0.001). There was no significant correlation between the presence of Ki-67-positive nuclei and histologic classification, largest tumor diameter, localization of themore » tumor, age, sex, scleral invasion, pigmentation, and lymphocytic infiltration. The relevance of Ki-67 immunohistochemistry for the assessment of the life prognosis of patients with uveal melanoma has to be studied prospectively.« less
  • We compared the survival of 302 patients with a primary choroidal or ciliary body melanoma treated by cobalt-60 plaque radiotherapy between 1976 and 1982 with the survival of 134 patients treated by enucleation during the same period. Tumor size, location of the anterior margin of the tumor, and patient age at the time of treatment were identified as simultaneous significant clinical variables for predicting melanoma-specific mortality by multivariate Cox proportional hazards modeling. We computed a prognostic index for each patient based on this model and found that patients in the enucleation group had slightly higher values of this index thanmore » did patients in the cobalt-60 plaque radiotherapy group. Risk ratios for the treatment effect computed from a Cox model incorporating prognostic index and the treatment variable were found to be approximately equal to 1, both for analysis of melanoma-specific mortality and total mortality. These results indicate that when one controls for differences in prognostic index between the groups, cobalt-60 plaque therapy and enucleation are essentially equivalent in their effect on survival.« less
  • A new prototype (hardware and software) for monitoring eye movements using a noninvasive technique for gated linac-based stereotactic radiotherapy (SRT) of uveal melanoma was developed. The prototype was tested within the scope of a study for 11 patients. Eye immobilization was achieved by having the patient fixate a light source integrated into the system. The system is used in conjunction with a Head and Neck mask system for immobilization, and uses infrared tracking technology for positioning (both BrainLAB AG Heimstetten/Germany). It was used during CT and MR image acquisition as well as during all of five treatment fractions (6 MeV,more » 5x12 Gy to 80% isodose) to guarantee identical patient setup and eye rotational state during treatment planning and treatment delivery. Maximum temporal and angular deviations tolerated during treatment delivery can be chosen by the physician, the radiation then being interrupted automatically and instantaneously if those criteria are being exceeded during irradiation. A graphical user interface displays life video images of the treated eye and information about the current and previous rotational deviation of the eye from its reference treatment position. The physician thus has online access to data directly linked to the success of the treatment and possible side effects. Mean angular deviations during CT/MR scans and treatment deliveries ranged from 1.61 deg. to 3.64 deg. (standard deviations 0.87 deg. to 2.09 deg.) which is in accordance with precision requirements for SRT. Typical situations when preset deviation criteria were exceeded are slow drifts (fatigue), sudden large eye movements (irritation), or if patients closed their eyes (fatigue). In these cases radiation was reliably interrupted by the gating system. In our clinical setup the novel system for computer-controlled eye movement gated treatments was well tolerated by all patients. The system yields quantitative real-time information about the eye's rotational state with respect to a reference position (treatment planning situation). Together with the possibility of performing movement-gated treatments of uveal melanoma, the system thus greatly improves the quality of this treatment.« less