Is It Possible to Preserve Vision without Compromising Metastases-Free Survival by Use of Fully Fractionated Stereotactic Radiotherapy for Posterior Choroidal Melanoma?
- Author(s)
- Phillips, CE; Youssef, A; Bressel, M; O'Day, R; Sia, J; McKenzie, JD; McKay, D; Campbell, W; Chen, FK;
- Details
- Publication Year 2024-06,Volume 10,Issue #2,Page 72-79
- Journal Title
- Ocular Oncology and Pathology
- Publication Type
- Research article
- Abstract
- INTRODUCTION: Stereotactic radiotherapy (SRT) is used for choroidal melanoma (CM) abutting the optic nerve. Visual acuity (VA) deterioration to ≤6/60 is common. We report a pilot study of reduced-dose SRT using 2 Gy/day, aiming to preserve vision without compromising survival. METHOD: 60 Gy SRT was delivered in 30 fractions over 6 weeks. Liver metastasis surveillance was annual ultrasound. The primary endpoint was 5-year metastasis-free survival (5yMFS). Secondary endpoints were 2-year freedom from local progression (2yFFLP), VA, enucleation rate, and radiation toxicity. RESULTS: Twenty adults aged ≤70 years with T1-T2M0 CM without diabetes mellitus were enrolled. Median follow-up was 5.1 years. About 85% and 90% of tumours were ≤3 mm of the macula and optic disc, respectively. Median tumour height was 2.2 mm (range 1.0-4.4 mm), and median basal diameter was 8.2 mm (range: 4.3-15.0 mm). 5yMFS was 88% (95% CI: 61-97), and the 2yFFLP rate was 90% (95%: CI 66-97). There were three enucleations for disease progression. Final VA in retained eyes was ≥6/7.5 in 6 (30%), 6/9 to 6/12 in 5 (25%), 6/15 to 6/48 in 2 (10%), and ≤6/60 in 4 (20%) eyes. Retinopathy was the main cause of vision loss besides tumour progression. CONCLUSION: Meaningful vision was preserved 5 years after SRT, despite high-risk tumour locations for vision loss. 2yFFLP and 5yMFS were acceptable. This dose fractionation warrants further investigation.
- Publisher
- Karger
- Keywords
- Posterior choroidal melanoma; Radiotherapy fractionation; Visual acuity
- Department(s)
- Radiation Oncology; Biostatistics and Clinical Trials
- Publisher's Version
- https://doi.org/10.1159/000538022
- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2024-08-27 04:40:35
Last Modified: 2024-08-27 04:48:12