Palladium-103 Radiation Therapy for Small Choroidal Melanoma
Management decisions for SMALL choroidal melanomas are more complicated. This is because, while many studies have shown that the risk for metastasis is lower for small melanomas, the complication rates for radiation treatment are viewed, grouped and reported for all sizes.
However, studies have shown that radiation dose to critical ocular structures can be used to predict side effects. Therefore, it was likely that treatment of smaller tumors would result in fewer ocular side effects and thus better visual acuities.
Unfortunately, it is even more complicated. Newman et al showed that choroidal melanomas are often found when they are small, centrally located near or touching the macula and thus causing early symptoms. When radiation is used to treat a tumor near or beneath the macula, the dose is higher to that central retina and thus more likely to affect visual acuity.
Treatment of small choroidal melanoma is typically a balance between destroying a tumor at low risk for metastatic disease versus the radiation treatment causing harm to the patients vision in that eye. This dilemma may cause eye cancer specialists to selectively use observation for growth before treatment (particularly for small, asymptomatic, centrally located tumors).
Growth can confirm that the tumor is malignant and will eventually harm vision (itself) if left untreated. However, in explanations to their patients, eye cancer specialists also explain that waiting for melanoma growth carries an unquantified, but likely very small increased risk of metastatic disease that is being balanced against the known risk of radiation-related vision loss. Surely, we all agree that if there were a treatment that did not risk vision, no one would suggest "observation of small melanomas."
Palladium-103 Radiation Therapy for Small Choroidal Melanoma November of 2013 by Semenova and Finger. Ophthalmology 2013;120:2353-2357
This study, supported by The Eye Cancer Foundation, was performed to better understand the modern risks of plaque radiation therapy for small choroidal melanomas and help doctors and their patients with informed consent.
This group of 72 choroidal melanomas were less than 2.5 millimeters in thickness and less than 10 mm in largest basal dimension. This study demonstrated that 103 Pd ophthalmic plaque radiotherapy could provide local tumor control and eye retention in 100% of patients with small choroidal melanomas at an average 54 months follow up. Further, it found that visual acuities of 20/200 or better were preserved in 94.4% of patients and that 69.4% were stable or improved compared with their pre-treatment visual acuity. At the end of this study, the patient's average post-treatment visual acuity was 20/63. Thirty-four patients (47.2%) developed radiation maculopathy or radiation optic neuropathy. Of these, 20 patients were succcessfully treated with periodic intravitreal anti-VEGF bevacizumab or ranibizumab injections to suppress their radiation-induced intraocular vasculopathy.
It is important to note that this study started prior to the use of anti-VEGF therapy for radiation retinopathy and that visual acuity results for patients who received anti-VEGF therapy were superior to those who did not.
Conclusion: Modern 103Pd plaque radiation therapy offered excellent local control and visual acuity outcomes for select patients with small choroidal melanoma
http://www.ncbi.nlm.nih.gov/pubmed/23774104
Retina Today Coverage of the ASRS Presentation
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However, studies have shown that radiation dose to critical ocular structures can be used to predict side effects. Therefore, it was likely that treatment of smaller tumors would result in fewer ocular side effects and thus better visual acuities.
Unfortunately, it is even more complicated. Newman et al showed that choroidal melanomas are often found when they are small, centrally located near or touching the macula and thus causing early symptoms. When radiation is used to treat a tumor near or beneath the macula, the dose is higher to that central retina and thus more likely to affect visual acuity.
Treatment of small choroidal melanoma is typically a balance between destroying a tumor at low risk for metastatic disease versus the radiation treatment causing harm to the patients vision in that eye. This dilemma may cause eye cancer specialists to selectively use observation for growth before treatment (particularly for small, asymptomatic, centrally located tumors).
Growth can confirm that the tumor is malignant and will eventually harm vision (itself) if left untreated. However, in explanations to their patients, eye cancer specialists also explain that waiting for melanoma growth carries an unquantified, but likely very small increased risk of metastatic disease that is being balanced against the known risk of radiation-related vision loss. Surely, we all agree that if there were a treatment that did not risk vision, no one would suggest "observation of small melanomas."
Palladium-103 Radiation Therapy for Small Choroidal Melanoma November of 2013 by Semenova and Finger. Ophthalmology 2013;120:2353-2357
This study, supported by The Eye Cancer Foundation, was performed to better understand the modern risks of plaque radiation therapy for small choroidal melanomas and help doctors and their patients with informed consent.
This group of 72 choroidal melanomas were less than 2.5 millimeters in thickness and less than 10 mm in largest basal dimension. This study demonstrated that 103 Pd ophthalmic plaque radiotherapy could provide local tumor control and eye retention in 100% of patients with small choroidal melanomas at an average 54 months follow up. Further, it found that visual acuities of 20/200 or better were preserved in 94.4% of patients and that 69.4% were stable or improved compared with their pre-treatment visual acuity. At the end of this study, the patient's average post-treatment visual acuity was 20/63. Thirty-four patients (47.2%) developed radiation maculopathy or radiation optic neuropathy. Of these, 20 patients were succcessfully treated with periodic intravitreal anti-VEGF bevacizumab or ranibizumab injections to suppress their radiation-induced intraocular vasculopathy.
It is important to note that this study started prior to the use of anti-VEGF therapy for radiation retinopathy and that visual acuity results for patients who received anti-VEGF therapy were superior to those who did not.
Conclusion: Modern 103Pd plaque radiation therapy offered excellent local control and visual acuity outcomes for select patients with small choroidal melanoma
http://www.ncbi.nlm.nih.gov/pubmed/23774104
Retina Today Coverage of the ASRS Presentation
Receive the latest news and opportunities from The Eye Cancer Foundation. Please fill out the form below.
