skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience

Abstract

Purpose: To report on the clinical outcome of LINAC-based stereotactic radiotherapy (SRT) of uveal melanomas. Additionally, a new prototype (hardware and software) for automated eye monitoring and gated SRT using a noninvasive eye fixation technique is described. Patients and Methods: Between June 1997 and March 2004, 158 patients suffering from uveal melanoma were treated at a LINAC with 6 MV (5 x 14 Gy; 5 x 12 Gy prescribed to 80% isodose) photon beams. To guarantee identical patient setup during treatment planning (CT and MRI) and treatment delivery, patients were immobilized with a BrainLAB thermoplastic mask. Eye immobilization was achieved by instructing the patient to fixate on a light source integrated into the mask system. A mini-video camera was used to provide on-line information about the eye and pupil position, respectively. A new CT and magnetic resonance (MR) compatible prototype, based on head-and-neck fixation and the infrared tracking system ExacTrac, has been developed and evaluated since 2002. This system records maximum temporal and angular deviations during treatment and, based on tolerance limits, a feedback signal to the LINAC enables gated SRT. Results: After a median follow-up of 33.4 months (range, 3-85 months), local control was achieved in 98%. Fifteen patientsmore » (9.0%) developed metastases. Secondary enucleation was performed in 23 patients (13.8%). Long-term side effects were retinopathy (n = 70; 44%), cataract (n = 30; 23%), optic neuropathy (n = 65; 41%), and secondary neovascular glaucoma (n = 23; 13.8%). Typical situations when preset deviation criteria were exceeded were slow drifts (fatigue), large sudden eye movements (irritation), or eye closing (fatigue). In these cases, radiation was reliably interrupted by the gating system. In our clinical setup, the novel system for computer-controlled gated SRT of uveal melanoma was well tolerated by about 30 of the patients treated with this system so far. Conclusion: LINAC-based SRT of uveal melanomas provides good local control. The new prototype system improves the quality of treatment and offers the possibility of movement-gated treatments. In an ongoing study, treatment-related side effects are correlated with dose levels. Such correlations can be used to further optimize linac-based SRT of uveal melanoma.« less

Authors:
 [1];  [1];  [1];  [2];  [1];  [1];  [1];  [1]
  1. Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital of Vienna, Vienna (Austria)
  2. Department of Ophthalmology, University of Vienna, General Hospital of Vienna, Vienna (Austria)
Publication Date:
OSTI Identifier:
20850192
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 66; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2006.01.005; PII: S0360-3016(06)00111-8; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CATARACTS; COMPUTER CODES; COMPUTERIZED TOMOGRAPHY; CORRELATIONS; FATIGUE; HEAD; LIGHT SOURCES; LINEAR ACCELERATORS; MELANOMAS; METASTASES; NECK; NMR IMAGING; PATIENTS; PHOTON BEAMS; RADIOTHERAPY; RESPIRATORS; SIDE EFFECTS; TELEVISION CAMERAS; THERMOPLASTICS

Citation Formats

Dieckmann, Karin, Georg, Dietmar, Bogner, Joachim, Zehetmayer, Martin, Petersch, Bernhard, Chorvat, Martin, Weitmann, Hajo, and Poetter, Richard. Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience. United States: N. p., 2006. Web. doi:10.1016/j.ijrobp.2006.01.005.
Dieckmann, Karin, Georg, Dietmar, Bogner, Joachim, Zehetmayer, Martin, Petersch, Bernhard, Chorvat, Martin, Weitmann, Hajo, & Poetter, Richard. Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience. United States. https://doi.org/10.1016/j.ijrobp.2006.01.005
Dieckmann, Karin, Georg, Dietmar, Bogner, Joachim, Zehetmayer, Martin, Petersch, Bernhard, Chorvat, Martin, Weitmann, Hajo, and Poetter, Richard. 2006. "Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience". United States. https://doi.org/10.1016/j.ijrobp.2006.01.005.
@article{osti_20850192,
title = {Optimizing LINAC-based stereotactic radiotherapy of uveal melanomas: 7 years' clinical experience},
author = {Dieckmann, Karin and Georg, Dietmar and Bogner, Joachim and Zehetmayer, Martin and Petersch, Bernhard and Chorvat, Martin and Weitmann, Hajo and Poetter, Richard},
abstractNote = {Purpose: To report on the clinical outcome of LINAC-based stereotactic radiotherapy (SRT) of uveal melanomas. Additionally, a new prototype (hardware and software) for automated eye monitoring and gated SRT using a noninvasive eye fixation technique is described. Patients and Methods: Between June 1997 and March 2004, 158 patients suffering from uveal melanoma were treated at a LINAC with 6 MV (5 x 14 Gy; 5 x 12 Gy prescribed to 80% isodose) photon beams. To guarantee identical patient setup during treatment planning (CT and MRI) and treatment delivery, patients were immobilized with a BrainLAB thermoplastic mask. Eye immobilization was achieved by instructing the patient to fixate on a light source integrated into the mask system. A mini-video camera was used to provide on-line information about the eye and pupil position, respectively. A new CT and magnetic resonance (MR) compatible prototype, based on head-and-neck fixation and the infrared tracking system ExacTrac, has been developed and evaluated since 2002. This system records maximum temporal and angular deviations during treatment and, based on tolerance limits, a feedback signal to the LINAC enables gated SRT. Results: After a median follow-up of 33.4 months (range, 3-85 months), local control was achieved in 98%. Fifteen patients (9.0%) developed metastases. Secondary enucleation was performed in 23 patients (13.8%). Long-term side effects were retinopathy (n = 70; 44%), cataract (n = 30; 23%), optic neuropathy (n = 65; 41%), and secondary neovascular glaucoma (n = 23; 13.8%). Typical situations when preset deviation criteria were exceeded were slow drifts (fatigue), large sudden eye movements (irritation), or eye closing (fatigue). In these cases, radiation was reliably interrupted by the gating system. In our clinical setup, the novel system for computer-controlled gated SRT of uveal melanoma was well tolerated by about 30 of the patients treated with this system so far. Conclusion: LINAC-based SRT of uveal melanomas provides good local control. The new prototype system improves the quality of treatment and offers the possibility of movement-gated treatments. In an ongoing study, treatment-related side effects are correlated with dose levels. Such correlations can be used to further optimize linac-based SRT of uveal melanoma.},
doi = {10.1016/j.ijrobp.2006.01.005},
url = {https://www.osti.gov/biblio/20850192}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 66,
place = {United States},
year = {Wed Nov 15 00:00:00 EST 2006},
month = {Wed Nov 15 00:00:00 EST 2006}
}