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Paul T. Finger - One of the best experts on this subject based on the ideXlab platform.

  • Palladium 103 plaque therapy for multifocal iris melanoma radiation of the entire anterior segment of the eye
    European Journal of Ophthalmology, 2020
    Co-Authors: Paul T. Finger, Ankit Singh Tomar, Kimberly J Chin
    Abstract:

    Purpose:To investigate the safety and tolerability of total anterior segment Palladium-103 (103Pd) eye plaque brachytherapy for multifocal iris melanoma.Methods:Interventional case series of 11 pat...

  • risk factors for cataract after Palladium 103 ophthalmic plaque radiation therapy
    International Journal of Radiation Oncology Biology Physics, 2011
    Co-Authors: Paul T. Finger, Kimberly J Chin, Neil S Patel
    Abstract:

    Purpose To examine how tumor characteristics and dose affect cataract development after plaque radiation therapy. Methods and Materials Three hundred and eighty-four patients were diagnosed with uveal melanoma and treated with Palladium-103 ( 103 Pd) plaque radiation therapy. Of these, 282 (74%) inclusion met exclusion criteria for follow-up time, tumor location, and phakic status. Then patient-, ophthalmic-, and radiation-specific factors (patient age, diabetes, hypertension, tumor location, tumor dimensions, and lens dose) were examined (by a Cox proportional regression model) as predictors for the development of radiation-related cataract. Results Radiation cataract developed in 76 (24%) of patients at a mean follow-up of 39.8 months (range, 1–192). Patients with anteriorly located tumors were noted to have a higher incidence of cataract at 43.0% (43 of 100 patients) vs. 18.1% (33 cataracts per 182 patients) for posteriorly located tumors ( p p for trend=0.0003) and higher lens dose ( p for trend=0.001) were the best predictors (biomarkers) for radiation cataract. Conclusions Although anterior tumor location, greater tumor height, and increased patient age (at treatment) were associated with significantly greater risk for radiation cataract, dose to lens was the most significant factor.

  • Palladium-103 eye plaque brachytherapy for primary adenocarcinoma of the ciliary body epithelium.
    Brachytherapy, 2011
    Co-Authors: Paul T. Finger, Julia E. Reid, Codrin Iacob
    Abstract:

    Abstract Purpose To present an interventional case report on the use of plaque brachytherapy for adenocarcinoma of the nonpigmented ciliary epithelium. Methods and materials A 36-year-old woman with unilateral right eye pain and finger counting vision was noted to have an anterior segment intraocular mass. It extended between the iris and lens and into the pupillary aperture. High-frequency ultrasound imaging revealed a ciliary body origin. A minimally invasive biopsy technique allowed for a cytology and histopathology diagnosis of primary adenocarcinoma of the ciliary epithelium. Treatment was performed with Palladium-103 ophthalmic plaque brachytherapy (80-Gy apex). Main outcome measures include visual acuity, local control, radiation complications, and metastatic disease. Results The patient presented with counting fingers vision, focal angle closure, cataract, and a 5.5-mm thick ciliary body malignancy. At 3 years after radiation therapy and 2.5 years after cataract extraction, her visual acuity was improved to 20/30 and the tumor residua stabilized at 60% of its initial thickness. There has been neither radiation-related keratopathy, retinopathy, optic neuropathy nor metastatic disease. Conclusions Plaque brachytherapy was used to treat primary adenocarcinoma of the ciliary epithelium. With 3-year followup, there has been excellent local control, preservation of the eye, and recovery of vision.

  • Palladium 103 103pd plaque radiation therapy for circumscribed choroidal hemangioma with retinal detachment
    Archives of Ophthalmology, 2004
    Co-Authors: Alexander Aizman, Paul T. Finger, Andrzej Szechter, Uri Shabto, Anthony M Berson
    Abstract:

    Objective To describe clinical experience with Palladium 103 ( 103 Pd)ophthalmic plaque radiotherapy for choroidal hemangioma. Methods One course of 103 Pd ophthalmic plaque radiotherapy was usedin each of 5 patients with circumscribed choroidal hemangioma who had progressiveloss of vision due to subretinal exudation. A mean apex dose of 2900 cGy (2900rad) was delivered. Functional tests of outcome included best-corrected visualacuity. Anatomic results included changes in tumor height and subretinal fluiddocumented by ophthalmoscopy, fluorescein angiography, and ultrasonography. Results All patients had complete resolution of subretinal fluid with reattachmentof the retina. All tumors decreased in height (mean, 50%) after treatment.Three patients (60%) demonstrated improvement in visual acuity at the lastfollow-up, and in 1 patient vision remained stable with resolution of metamorphopsia.Twenty-four months after treatment, 1 patient whose visual acuity had recoveredfrom 20/160 to 20/32 had a loss of vision to 20/160 because of radiation maculopathy.For all patients, a mean visual acuity improvement of 2 lines was documented(95% confidence interval, 0.23-0.88). Mean follow-up was 18.6 months (range,6-29 months). Conclusions A single 103 Pd plaque radiation treatment was effective indecreasing tumor height, eliminating subretinal fluid, and improving visualacuity in patients with symptomatic circumscribed choroidal hemangiomas.

  • ophthalmic plaque radiotherapy for age related macular degeneration associated with subretinal neovascularization
    American Journal of Ophthalmology, 1999
    Co-Authors: Paul T. Finger, Anthony M Berson, Andrzej Szechter
    Abstract:

    Abstract PURPOSE: To evaluate ophthalmic plaque radiotherapy for the treatment of subretinal neovascularization associated with age-related macular degeneration. METHODS: In a prospective phase I clinical trial, we treated 23 patients (23 eyes) with ophthalmic plaque radiotherapy for subfoveal exudative macular degeneration. Palladium 103 ophthalmic plaque brachytherapy was delivered to a retinal apex dose of 1,250 to 2,362 cGy (rad). Early Treatment Diabetic Retinopathy Study type visual acuity determinations, ophthalmic examinations, and angiography were performed before and after treatment. Clinical evaluations were performed in a nonrandomized and unmasked fashion. RESULTS: Patients were followed up for a mean (±SD) of 19 ± 10.7 months (range, 3 to 37 months). Six months after radiation therapy, three (16%) of 19 eyes had lost 3 or more lines of best-corrected visual acuity; 12 months after radiation therapy, four eyes (31% of 13 eyes), and 24 months after radiation therapy, only two (22% of nine eyes) lost 3 or more lines of visual acuity. No eye suffered sudden irreversible loss of central vision. No radiation retinopathy, optic neuropathy, or cataract could be attributed to radiotherapy within this follow-up period. CONCLUSION: Ophthalmic plaque radiotherapy can be used to treat neovascular age-related macular degeneration. In contrast to external beam radiotherapy, ophthalmic plaque radiotherapy is a unilateral treatment, which allows a larger dose to be delivered to the macula with less irradiation of normal ocular structures. We have found no sight-limiting complications at the doses, dose rates, and follow-up evaluated in this study.

Thomas W Feeley - One of the best experts on this subject based on the ideXlab platform.

  • patient reported health related quality of life for men treated with low dose rate prostate brachytherapy as monotherapy with 125 iodine 103 Palladium or 131 cesium results of a prospective phase ii study
    Brachytherapy, 2017
    Co-Authors: Pierre Blanchard, Thomas J Pugh, David A Swanson, Usama Mahmood, Hsiang Chun Chen, Xuemei Wang, William J Graber, Rajat J Kudchadker, Teresa L Bruno, Thomas W Feeley
    Abstract:

    Abstract Purpose To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. Methods and Materials Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. Results From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), Palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. Conclusions The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.

  • patient reported health related quality of life for men treated with low dose rate prostate brachytherapy as monotherapy with 125 iodine 103 Palladium or 131 cesium results of a prospective phase ii study
    Brachytherapy, 2017
    Co-Authors: Pierre Blanchard, Thomas J Pugh, David A Swanson, Usama Mahmood, Hsiang Chun Chen, Xuemei Wang, William J Graber, Rajat J Kudchadker, Teresa L Bruno, Thomas W Feeley
    Abstract:

    Abstract Purpose To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. Methods and Materials Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. Results From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), Palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. Conclusions The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.

Anthony M Berson - One of the best experts on this subject based on the ideXlab platform.

  • Palladium 103 103pd plaque radiation therapy for circumscribed choroidal hemangioma with retinal detachment
    Archives of Ophthalmology, 2004
    Co-Authors: Alexander Aizman, Paul T. Finger, Andrzej Szechter, Uri Shabto, Anthony M Berson
    Abstract:

    Objective To describe clinical experience with Palladium 103 ( 103 Pd)ophthalmic plaque radiotherapy for choroidal hemangioma. Methods One course of 103 Pd ophthalmic plaque radiotherapy was usedin each of 5 patients with circumscribed choroidal hemangioma who had progressiveloss of vision due to subretinal exudation. A mean apex dose of 2900 cGy (2900rad) was delivered. Functional tests of outcome included best-corrected visualacuity. Anatomic results included changes in tumor height and subretinal fluiddocumented by ophthalmoscopy, fluorescein angiography, and ultrasonography. Results All patients had complete resolution of subretinal fluid with reattachmentof the retina. All tumors decreased in height (mean, 50%) after treatment.Three patients (60%) demonstrated improvement in visual acuity at the lastfollow-up, and in 1 patient vision remained stable with resolution of metamorphopsia.Twenty-four months after treatment, 1 patient whose visual acuity had recoveredfrom 20/160 to 20/32 had a loss of vision to 20/160 because of radiation maculopathy.For all patients, a mean visual acuity improvement of 2 lines was documented(95% confidence interval, 0.23-0.88). Mean follow-up was 18.6 months (range,6-29 months). Conclusions A single 103 Pd plaque radiation treatment was effective indecreasing tumor height, eliminating subretinal fluid, and improving visualacuity in patients with symptomatic circumscribed choroidal hemangiomas.

  • ophthalmic plaque radiotherapy for age related macular degeneration associated with subretinal neovascularization
    American Journal of Ophthalmology, 1999
    Co-Authors: Paul T. Finger, Anthony M Berson, Andrzej Szechter
    Abstract:

    Abstract PURPOSE: To evaluate ophthalmic plaque radiotherapy for the treatment of subretinal neovascularization associated with age-related macular degeneration. METHODS: In a prospective phase I clinical trial, we treated 23 patients (23 eyes) with ophthalmic plaque radiotherapy for subfoveal exudative macular degeneration. Palladium 103 ophthalmic plaque brachytherapy was delivered to a retinal apex dose of 1,250 to 2,362 cGy (rad). Early Treatment Diabetic Retinopathy Study type visual acuity determinations, ophthalmic examinations, and angiography were performed before and after treatment. Clinical evaluations were performed in a nonrandomized and unmasked fashion. RESULTS: Patients were followed up for a mean (±SD) of 19 ± 10.7 months (range, 3 to 37 months). Six months after radiation therapy, three (16%) of 19 eyes had lost 3 or more lines of best-corrected visual acuity; 12 months after radiation therapy, four eyes (31% of 13 eyes), and 24 months after radiation therapy, only two (22% of nine eyes) lost 3 or more lines of visual acuity. No eye suffered sudden irreversible loss of central vision. No radiation retinopathy, optic neuropathy, or cataract could be attributed to radiotherapy within this follow-up period. CONCLUSION: Ophthalmic plaque radiotherapy can be used to treat neovascular age-related macular degeneration. In contrast to external beam radiotherapy, ophthalmic plaque radiotherapy is a unilateral treatment, which allows a larger dose to be delivered to the macula with less irradiation of normal ocular structures. We have found no sight-limiting complications at the doses, dose rates, and follow-up evaluated in this study.

  • three dimensional ultrasonography of choroidal melanoma localization of radioactive eye plaques
    Archives of Ophthalmology, 1998
    Co-Authors: Paul T. Finger, Juan M Romero, Richard B Rosen, Raymond Iezzi, Richard Emery, Anthony M Berson
    Abstract:

    Objective To evaluate the use of 3-dimensional (3D) ultrasonography for the localization of episcleral eye plaques during the treatment of choroidal melanomas. Methods A series of 13 patients with choroidal melanoma were treated with radioactive Palladium 103 seeds affixed into gold eye plaques. During surgery, 3D ultrasonography was performed with a commercially available system to evaluate the relative position of radioactive plaques secured beneath their intraocular tumors. This system consists of an automated, rotating, handheld, B-scan ultrasonographic probe operating at 10 MHz, a personal computer, and 3D imaging software. Results We measured the margins of the plaque extending beyond the tumor and the distance between the radioactive seeds and the tumor apex. We also evaluated the relationship between the plaque edge, the episclera, and the tumor's edges. While the plaques were well centered over the tumor in all cases, the plaque margins around the tumor were found to be variably sized. When comparing measurements taken at the time of plaque insertion with those taken at the time of plaque removal, we noted changes in the apical tumor height and in plaque centration. In the 1 patient with a juxtapapillary tumor, the posterior margin of the plaque was found to be displaced away from the sclera, or "tilted." Conclusions Three-dimensional ultrasonography offers a new method for ophthalmic plaque localization. Unique perspectives can be visualized through the use of computer-aided 3D reconstructions that permit the assessment of the relative position of the plaque to the optic nerve and the measurement of the distance between the in vivo radioactive seed and the tumor apex. Our experience suggests that when compared with 2-dimensional ultrasonography, 3D ultrasonography offers new capabilities that can be used to improve plaque placement and radiation dose calculations.

Kent E Wallner - One of the best experts on this subject based on the ideXlab platform.

  • prostatic acid phosphatase adversely affects cause specific survival in patients with intermediate to high risk prostate cancer treated with brachytherapy
    Urology, 2008
    Co-Authors: Christine L Fang, Al V. Taira, Michael Dattoli, Lawrence D True, Richard Sorace, Kent E Wallner
    Abstract:

    Objectives To perform a retrospective analysis to assess the utility of pretreatment serum prostatic acid phosphatase (PAP) as a predictor of cause-specific survival (CSS) in patients with higher risk prostate cancer treated with Palladium-103 ( 103 Pd) brachytherapy and supplemental external beam radiotherapy (EBRT). Methods From 1992 to 1996, 193 patients with clinically localized prostate adenocarcinoma, a pretreatment PAP level, and Gleason score 7 or more, and/or a prostate-specific antigen (PSA) level of 10 ng/mL or more were treated with 103 Pd brachytherapy and supplemental EBRT. The patients underwent EBRT of 41.4 Gy to a limited pelvic field and 103 Pd brachytherapy with a prescribed minimum 103 Pd dose of 80 Gy. Multivariate analysis was performed to analyze the predictive value of PAP, PSA, and Gleason score on CSS. Results The 10-year CSS rate for patients with a PAP level of less than 1.5, 1.5 to 2.4, and 2.5 U/L or more was 93%, 87%, and 75%, respectively ( P = 0.013). The 10-year CSS rate for patients with a PSA level of less than 10, 10 to 20, and greater than 20 ng/mL was 92%, 76%, and 83%, respectively ( P = 0.393). The 10-year CSS rate for patients with a Gleason score of 6, 7, 8, and 9 was 90%, 89%, 70%, and 68%, respectively ( P = 0.002). On Cox multivariate regression analysis, PAP (hazard ratio 1.31, P P = 0.0007) were associated with CSS. PSA was not predictive of CSS ( P = 0.393). Conclusions The results of this study demonstrated that PAP is a stronger predictor of CSS than PSA or Gleason score in men with higher risk prostate cancer treated with 103 Pd brachytherapy and EBRT. Given the findings of this analysis, the use of PAP should be reconsidered in these patients.

  • prognostic role of serum prostatic acid phosphatase for 103pd based radiation for prostatic carcinoma
    International Journal of Radiation Oncology Biology Physics, 1999
    Co-Authors: Michael Dattoli, Lawrence D True, Richard Sorace, Kent E Wallner, Jennifer Cash, John M Koval, Rudolph Acosta, Mohendra Biswas, Michael Binder, Brent Sullivan
    Abstract:

    Abstract Purpose: To establish the prognostic role of serum enzymatic prostatic acid phosphatase (PAP) in patients treated with Palladium ( 103 Pd) and supplemental external beam irradiation (EBRT) for clinically localized, high-risk prostate carcinoma. Methods and Materials: One hundred twenty-four consecutive patients with Stage T2a–T3 prostatic carcinoma were treated from 1992 through 1995. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (100 patients), Gleason score 7–10 (40 patients), pretreatment prostate specific antigen (PSA) > 15 ng/ml (32 patients), or elevated serum PAP (25 patients). Patients received 41 Gy conformal EBRT to a limited pelvic field, followed 4 weeks later by a 103 Pd boost (prescription dose 80 Gy). Biochemical failure was defined as a PSA greater than 1 ng/ml (normal Results: The overall, actuarial freedom from biochemical failure at 4 years after treatment was 79%. In Cox-proportional hazard multivariate analysis, the strongest predictor of failure was elevated pretreatment acid phosphatase ( p = 0.02), followed by Gleason score ( p = 0.1), and PSA ( p = 0.14). Conclusion: PAP was the strongest predictor of long-term biochemical failure. It may be a more accurate indicator of micrometastatic disease than PSA, and as such, we suggest that it be reconsidered for general use in radiation-treated patients.

Pierre Blanchard - One of the best experts on this subject based on the ideXlab platform.

  • patient reported health related quality of life for men treated with low dose rate prostate brachytherapy as monotherapy with 125 iodine 103 Palladium or 131 cesium results of a prospective phase ii study
    Brachytherapy, 2017
    Co-Authors: Pierre Blanchard, Thomas J Pugh, David A Swanson, Usama Mahmood, Hsiang Chun Chen, Xuemei Wang, William J Graber, Rajat J Kudchadker, Teresa L Bruno, Thomas W Feeley
    Abstract:

    Abstract Purpose To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. Methods and Materials Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. Results From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), Palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. Conclusions The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.

  • patient reported health related quality of life for men treated with low dose rate prostate brachytherapy as monotherapy with 125 iodine 103 Palladium or 131 cesium results of a prospective phase ii study
    Brachytherapy, 2017
    Co-Authors: Pierre Blanchard, Thomas J Pugh, David A Swanson, Usama Mahmood, Hsiang Chun Chen, Xuemei Wang, William J Graber, Rajat J Kudchadker, Teresa L Bruno, Thomas W Feeley
    Abstract:

    Abstract Purpose To compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes. Methods and Materials Patients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs. Results From 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), Palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively. Conclusions The three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.