Purpose
To investigate the clinical outcomes of stereotactic body radiation therapy (SBRT) in patients with large uveal melanoma (UM).
Materials and Methods
We conducted a retrospective review of 64 consecutive patients with UM treated with Cyberknife at Yonsei Cancer Center from September 2015 to October 2021. The median radiation dose was 60 Gy (range 48-64 Gy) administered in four fractions every alternate day. The local failure-free rate (LFFR), distant metastasis-free rate (DMFR), progression-free survival (PFS), and overall survival (OS) were assessed using the Kaplan–Meier method and log-rank test. Cox regression analysis was performed to analyze the predictive factors affecting survival outcomes and the factors associated with vision loss.
Results
The median tumor diameter and height were 11.5 mm and 8.4 mm, respectively. After a median follow-up of 32.1 months (range 4.9–89.9), the 3-year LFFR, DMFR, PFS, and OS were 89.5%, 70.5%, 65.5%, and 89.4%, respectively. Enucleation was performed in 13 (20.3%) patients, with three cases attributed to disease progression. A larger tumor diameter was associated with significantly worse DMFR (HR=1.35, p=0.015) and OS (HR=1.49, p=0.026) in the multivariate analysis. Regarding visual prognosis, 41 (64.1%) patients had baseline visual acuity ≥20/200, but only 4 (6.3%) patients maintained visual acuity ≥20/200 by the final follow-up. Initial visual acuity ≥20/40 (HR 0.45, p=0.030) was the single favorable significant factor predicting visual retention ≥20/200 in multivariate analysis.
Conclusion
SBRT using CyberKnife demonstrated a comparable local control rate to that observed in historical studies for patients with large UM. Distant metastasis and treatment-related ocular toxicity remain the limitations of this treatment.
Jung Woo Han, Christopher Seungkyu Lee, Seung Min Hahn, Won Kee Ahn, Hyo Sun Kim, Hyeseon Yun, Sung Chul Lee, Byung Moon Kim, Dong Joon Kim, Chuhl Joo Lyu
Cancer Res Treat. 2023;55(1):270-278. Published online May 24, 2022
Purpose The advances in the treatment of retinoblastoma have enabled salvaging the globe in advanced stages with intra-arterial chemotherapy (IAC). We developed a strategy of alternate application of systemic intravenous chemotherapy (IVC) and IAC (referred to as alternate systemic IVC and IAC; ASIAC) to reduce central nervous metastases during IAC and examined its efficacy and safety in eye globe salvage in this study.
Materials and Methods Between January 2010 and February 2021, 43 eyes of 40 patients received ASIAC treatment for retinoblastoma at the Yonsei Cancer Center, Yonsei University Health System. Their medical records were reviewed retrospectively to evaluate the eye salvage rate (ESR), defined from diagnosis to enucleation. High-risk retinoblastoma was defined as group D or E by the International Classification of Retinoblastoma.
Results The study enrolled 38 and five cases of high-risk and low-risk retinoblastoma, respectively. In total, 178 IAC and 410 IVC courses were administered, with a median of 4 (interquartile range [IQR], 3.0 to 5.0) IAC and 9 (IQR, 6.0 to 11) IVC courses per eye, respectively. The 5-year ESR was 60.4%±8.7% for the whole cohort, 100% for low-risk retinoblastoma, and 53.6%±9.8% for high-risk retinoblastoma. Among those diagnosed since 2015, the 5-year ESR for high-risk retinoblastoma was 63.5%±14.0%. Fifteen eyes underwent enucleation; no viable tumor was found in three enucleated eyes. There were no deaths in this cohort.
Conclusion Primary IAC-IVC (i.e., ASIAC) for patients with retinoblastoma was tolerable and effective in salvaging the eye and maintaining survival.
Citations
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