Feasibility, Method and Early Outcome of Image-Guided Volumetric Modulated Arc Radiosurgery Followed by Resection for AJCC Stage IIA–IIIB High-Risk Large Intraocular Melanoma

Author:

Guberina MajaORCID,Sokolenko Ekaterina,Guberina Nika,Dalbah Sami,Pöttgen ChristophORCID,Lübcke Wolfgang,Indenkämpen Frank,Lachmuth Manfred,Flühs Dirk,Chen Ying,Hoffmann Christian,Deuschl CorneliusORCID,Jabbarli Leyla,Fiorentzis MiltiadisORCID,Foerster Andreas,Rating PhilippORCID,Ebenau Melanie,Grunewald Tobias,Bechrakis Nikolaos,Stuschke Martin

Abstract

The main objective of this prospective observational study was the characterization of the feasibility and early outcome of image-guided (IG) volumetric modulated arc (VMAT) radiosurgery (SRS) followed by resection for patients with large intraocular melanoma. Our study included consecutive patients with unfavorable-risk melanoma, enrolled in an ophthalmic oncology center. IG-VMAT-SRS was applied by high-resolution 4D image guidance and monitoring. Current stereotactic technique parameters were evaluated for comparison. Side effects and eye function, based on a 5-point CTC assessment score, were quantified. In patients with tumors located more than 0.7–1 mm apart from the optic nerve, partial to complete volume-sparing of the optic nerve head could be achieved. In 95.5% of this subgroup, the vitality of the optic nerve and vision could be preserved by the multimodality-treatment approach (mean follow-up: 18 months (7.5–36 months)). The advanced technology of stereotactic radiotherapy demonstrated the achievability of steep dose gradients around the high-dose volume, with 4D-IG-VMAT dose application. These results enforce IG-VMAT-SRS followed by resection as one of the major therapeutic options for patients with large intraocular melanoma. The combination of 4D-IG high-precision SRS and resection provides an effective treatment for large intraocular melanoma, with few side effects, and enables an eye bulb and even vision preserving modus operandi.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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1. Aspirin;Reactions Weekly;2023-04-01

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