Personalized re-treatment strategy for uveal melanoma local recurrences after interventional radiotherapy (brachytherapy): single institution experience and systematic literature review
Tagliaferri L (1), Pagliara MM (2,3), Fionda B (1), Scupola A (1,3), Azario L (4,5), Sammarco MG (2,3), Autorino R (1), Lancellotta V (6), Cammelli S(7), Caputo CG (8), Martinez-Monge R (9), Kovács G (10), Gambacorta MA (1,11), Valentini V (1,11), Blasi MA (2,3).
(1) U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy.
(2) Istituto di Oftalmologia, Università Cattolica del Sacro Cuore, Roma, Italy.
(3) UOC di Oncologia Oculare, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy.
(4) U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italy.
(5) Istituto di Fisica, Università Cattolica del Sacro Cuore, Roma, Italy.
(6) University of Perugia and Perugia General Hospital, Radiation Oncology Section, Perugia, Italy.
(7) Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
(8) Istituto di Oftalmologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
(9) Clìnica Universidad de Navarra, Navarra, Spain.
(10) Interdisciplinary Brachytherapy Unit, University of Lübeck - University Hospital S-H, Campus Lübeck, Germany.
(11) Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy.
To report the results of a patient's tailored therapeutic approach using a second course of interventional radiotherapy (brachytherapy) in patients with locally recurrent uveal melanoma.
Material and methods:
Patients who had already undergone ocular brachytherapy treated at our IOC (Interventional Oncology Center) were considered. Five patients who has received a second course of treatment with a plaque after local recurrences were included in our study.
Re-irradiation was performed with Ruthenium-106 (prescribed dose to the apex 100 Gy) or with Iodine-125 plaques (prescribed dose to the apex 85 Gy). Moreover, a systematic literature search was conducted through three electronic databases, including Medline/PubMed, Scopus, and Embase.
All patients were initially treated with Ruthenium-106 plaque; the re-irradiation was performed with Ruthenium-106 plaque in three cases and with Iodine in two cases. Mean time between the first and the second plaque was 56.8 months (range, 25-93 months). Local tumor control rate was 100%, no patient underwent secondary enucleation owing to re-treatment failure.
Distant metastasis occurred in 1 patient after 6 months from re-treatment. After a median follow-up of 44.2 months (range, 26-65 months) from re-treatment, all patients experienced worsening of the visual acuity (median visual acuity was 0.42 at time of recurrence and decline to 0.24 at the most recent follow-up); cataract occurred in two cases, no patient developed scleral necrosis. We considered 2 papers for a systematic review.
In selected cases, especially in presence of marginal local recurrence, a personalized re-treatment strategy with a plaque may offer high probability of tumor control and organ preservation but worsening of visual acuity.
CITATION J Contemp Brachytherapy. 2019 Feb;11(1):54-60. doi: 10.5114/jcb.2019.82888