2014 Guidelines for Plaque Radiation Therapy
2014 Guidelines for Plaque Radiation Therapy for Choroidal Melanoma and Retinoblastoma Published
The American Brachytherapy Society asked Dr. Finger to form a committee to study clinical eye plaque radiation therapy in an effort to develop modern consensus guidelines. To broadly reflect current international practice patterns, the ABS Ophthalmic Oncology Task Force included 47 eye cancer specialists (radiation oncologists, medical physicists and ophthalmic oncologists) from 10 countries (Canada, Finland, France, Germany, India, Japan, United Kingdom, the United States, Russia and Sweden). In what became a two-year process, they combined the published literature with their cumulative clinical experience to develop specific recommendations. This month, January 2014, the new guidelines were published in the journal, BRACHTHERAPY.
Specific 2014 ABS Case Selection Recommendations
1) Clinical diagnosis of uveal melanoma is adequate for treatment.
Histopathologic verification (biopsy) is not required.
2) Small melanomas can be treated at the eye cancer specialist’s discretion.
3) AJCC T1, T2, T3, and large T4a-d uveal melanoma patients can be treated,
after counseling about likely vision, eye retention, and local control
4) Patients with peripapillary and subfoveal and those with exudative retinal
detachments typically have poorer resultant vision and local control
outcomes. These patients should be accordingly counseled.
5) Tumors with T4e extraocular extension, basal diameters that exceed the
limits of brachytherapy, blind painful eyes, and those with no light
perception vision are not suitable for plaque therapy.
ABS = American Brachytherapy Society; COMS = Collaborative Ocular Melanoma Study; AJCC = American Joint Commission on Cancer. 106Ru and 90Sr plaques are less accommodating for nodular extrascleral extension.
Other Highlights Include
1) Centers should use the 7th edition AJCC staging system.
2) Centers should comply with the medical physics, dosimetry and quality assurance recommendations of the American Association for Physicists in Medicine –ABS Task Group 129.
To read the "open access" TG-129 medical physics guidelines and clinical summary, CLICK BELOW:
3) The tumor’s base should be covered by the plaque.
4) Patients should be treated at subspecialty eye cancer centers with certified personnel experienced in plaque construction, dosimetry and surgery.
5) Each center should track and periodically report their local control and complication rates.
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