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G Langmann - One of the best experts on this subject based on the ideXlab platform.
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tumor parameters predict the risk of side effects after Ruthenium 106 plaque brachytherapy of uveal melanomas
PLOS ONE, 2017Co-Authors: Lisa Tarmann, Werner Wackernagel, M Schneider, Peter Winkler, Domagoj Ivastinovic, G LangmannAbstract:BACKGROUND: To report on radiation-related side effects and complications after Ruthenium-106 plaque brachytherapy of uveal melanomas. METHODS: Medical records of 143 eyes with uveal melanoma, treated by Ruthenium-106 brachytherapy between 1997 and 2012 at a single center, were analyzed. We evaluated the occurrence of radiation-related side effects on the anterior and posterior segment of the eye. The influence of patient, tumor and treatment parameters on outcome was analyzed by multivariate time to event analysis considering competing risks. RESULTS: The median overall follow-up was 37.9 months. After treatment, the estimated risk at 12, 24 and 48 months for developing anterior segment complications was 25.3%, 37.5% and 50.3% for cataract formation and 5.4%, 6.4% and 8.1% for secondary glaucoma, respectively. The estimated risk for the occurrence of posterior segment complications 12, 24 and 48 months after treatment was 3.1%, 6.7% and 18.3% for radiation retinopathy, 18.3%, 27.1% and 42.6% for radiation maculopathy and 16.5%, 21.0% and 32.8% for radiation neuropathy, respectively. The risk of an increase in retinal detachment after treatment was 14.7%, 14.7% and 17.4% at 12, 24 and 48 months, respectively. The risk of vitreous hemorrhage occurring after treatment was 6.2%, 8.1% and 12.7%, and the risk of tumor vasculopathy was 15.4%, 17.4% and 19.0%. Scleral necrosis was observed in one patient. CONCLUSION: Radiation-related side effects and complications are common among patients treated with Ruthenium brachytherapy for uveal melanoma. However, the risk for those largely depends on individual tumor parameters. Before treatment, patients should be informed of their specific risks to develop various side effects. Patient information before treatment should cover not only general information about the treatment and possible complications and side effects but should also give details on the specific risks of the patient in her individual situation. This also includes elucidating the patient's individual resources and expectations and her willingness for long-term regular follow-up examinations and secondary adjunct treatments.
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Ruthenium 106 plaque brachytherapy for uveal melanoma
British Journal of Ophthalmology, 2015Co-Authors: Lisa Tarmann, Werner Wackernagel, Alexander Avian, Christoph Mayer, M Schneider, Peter Winkler, G LangmannAbstract:Background To report on local tumour control, eye preservation and visual outcome after Ruthenium-106 brachytherapy for uveal melanoma. Methods Medical records of 143 eyes with uveal melanoma, treated by Ruthenium-106 brachytherapy between 1997 and 2012 at one single centre, were included. Primary outcome measures were local tumour control, eye preservation and visual outcome. The influence of patient, tumour and treatment parameters on outcome was analysed by time to event analysis and competing risk regression. Results The median overall follow-up was 37.9 months. Tumour control: recurrent tumour growth was observed in 17 patients. The estimated local tumour recurrence rate at 12, 24 and 48 months after irradiation was 3%, 8.4% and 14.7%, respectively. The only significant risk factors for tumour recurrence were age (p=0.046) and reduced initial visual acuity (VA, p=0.045). No significant difference could be shown for tumour size or tumour category (T1–T2 vs T3–T4), and for any other tumour or treatment parameters (including combined transpupillary thermo-therapy (TTT)). Eye preservation: The likelihood of keeping the eye 12, 24 and 48 months after irradiation was 97.7%, 94.7% and 91.8%, respectively. Most significant risk factors for secondary enucleation were initial VA (p Vision The chances of keeping VA of 20/200 or better at 1, 2 and 5 years after treatment were 86.4%, 80.8% and 61.7%, respectively. Patients receiving sandwich-TTT showed significantly worse visual outcomes. Conclusions Ruthenium-106 brachytherapy appears to be a useful treatment regarding tumour control, eye preservation and visual function. Adjunct sandwich therapy resulted in worse visual outcome.
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Impact of Dose Rate on Clinical Course in Uveal Melanoma after Brachytherapy with Ruthenium-106
Strahlentherapie und Onkologie, 2007Co-Authors: Georg Mossböck, Peter Winkler, Thomas Rauscher, Karin S. Kapp, G LangmannAbstract:Background and Purpose: It has been suggested that the actual dose rate of an irradiating source may be a distinct influencing factor for the biological effect after brachytherapy with Ruthenium-106 for uveal melanoma. The purpose of this study was to investigate a hypothesized impact of the dose rate on the clinical and echographic course after brachytherapy. Patients and Methods: In total, 45 patients were included in this retrospective study. According to the actual dose rate, two groups were defined: group 1 with a dose rate < 4 Gy/h and group 2 with a dose rate ≥ 4 Gy/h. Regarding age, tumor height, basal diameter, scleral and apical dose, differences between the groups were not significant. Clinical parameters, including early and late side effects, and echographic courses were compared. Results: A significantly lower metastatic rate was found in group 2. Using univariate Cox proportional hazards regression, only dose rate predicted metastatic spread significantly (p < 0.05), while in a multivariate analysis, using age at the time of treatment, greatest tumor height and greatest basal diameter as covariates, the variable dose rate was of borderline significance (p = 0.077). Patients in group 2 had more early side effects and more pronounced visual decline, but these differences were of borderline significance with p-values of 0.072 and 0.064, respectively. Conclusion: These data suggest that a higher dose rate may confer a lower risk for metastatic spread, but may be associated with more side effects and more pronounced visual decline. Hintergrund und Ziel: Es wurde vermutet, dass die Dosisrate einer Strahlenquelle einen maßgeblichen Faktor für den biologischen Effekt nach Brachytherapie mit Ruthenium-106 beim uvealen Melanom darstellt. Ziel dieser Studie war die Untersuchung des Einflusses der Dosisrate auf den klinischen und echographischen Verlauf nach Brachytherapie. Patienten und Methodik: Insgesamt wurden 45 Patienten in diese retrospektive Studie eingeschlossen. Entsprechend der Dosisrate zum Zeitpunkt der Brachytherapie wurden zwei Gruppen definiert: Gruppe 1 mit einer Dosisrate < 4 Gy/h und Gruppe 2 mit einer Dosisrate ≥ 4 Gy/h. Bezüglich des Alters, der Tumorhöhe, des basalen Durchmessers sowie der Sklerakontakt- und apikalen Dosis bestand kein signifikanter Unterschied zwischen den beiden Gruppen. Klinische Parameter inklusive früher und später Nebenwirkungen sowie der echographische Verlauf wurden verglichen. Ergebnisse: Es fand sich eine signifikant niedrigere Metastasierungsrate in Gruppe 2. Mit der univariaten Cox-Regression zeigte sich nur für die Dosisrate ein signifikanter Zusammenhang (p < 0,05), während der Zusammenhang in der multivariaten Analyse mit Alter, größter Tumorhöhe und größtem Tumordurchmesser als Kovariablen grenzwertig war (p = 0,077). Patienten der Gruppe 2 hatten eine höhere Rate an frühen Nebenwirkungen und einen größeren Visusverlust, wobei die Unterschiede grenzwertig signifikant waren (p = 0,072 bzw. p = 0,064). Schlussfolgerung: Diese Daten lassen vermuten, dass eine höhere Dosisrate ein niedrigeres Metastasierungsrisiko aufweist, aber mit einer höheren Rate an Nebenwirkungen und größerem Visusverlust assoziiert ist.
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impact of dose rate on clinical course in uveal melanoma after brachytherapy with Ruthenium 106
Strahlentherapie Und Onkologie, 2007Co-Authors: Georg Mossböck, Peter Winkler, Thomas Rauscher, Karin S. Kapp, G LangmannAbstract:Background and Purpose: It has been suggested that the actual dose rate of an irradiating source may be a distinct influencing factor for the biological effect after brachytherapy with Ruthenium-106 for uveal melanoma. The purpose of this study was to investigate a hypothesized impact of the dose rate on the clinical and echographic course after brachytherapy. Patients and Methods: In total, 45 patients were included in this retrospective study. According to the actual dose rate, two groups were defined: group 1 with a dose rate < 4 Gy/h and group 2 with a dose rate ≥ 4 Gy/h. Regarding age, tumor height, basal diameter, scleral and apical dose, differences between the groups were not significant. Clinical parameters, including early and late side effects, and echographic courses were compared. Results: A significantly lower metastatic rate was found in group 2. Using univariate Cox proportional hazards regression, only dose rate predicted metastatic spread significantly (p < 0.05), while in a multivariate analysis, using age at the time of treatment, greatest tumor height and greatest basal diameter as covariates, the variable dose rate was of borderline significance (p = 0.077). Patients in group 2 had more early side effects and more pronounced visual decline, but these differences were of borderline significance with p-values of 0.072 and 0.064, respectively. Conclusion: These data suggest that a higher dose rate may confer a lower risk for metastatic spread, but may be associated with more side effects and more pronounced visual decline.
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Über den Stellenwert der Ruthenium-106- Brachytherapie bei der Therapie von Aderhautmelanomen
Spektrum der Augenheilkunde, 2002Co-Authors: G Langmann, G. Mosböck, G. Stücklschwaiger, K. Müllner, H. Lechner, J. FaulbornAbstract:Die an der Universitäts-Augenklinik Graz seit ihrer Einführung im Jahr 1985 mit Ruthenium 106 behandelten Aderhautmelanome wurden in Hinblick auf klinischen Verlauf, Komplikationen und Sehschärfe untersucht. Patienten und Methode In Form einer retrospektiven Studie wurden 47 Patienten, die zwischen 1985 und 2000 mit Ruthenium 106 behandelt wurden (medianer Nachbeobachtungszeitraum 22 Monate [8–152 Monate]), mittels Kaplan Meiers statistischer Evaluierung untersucht. Ergebnisse Die lokale Tumorkontrollrate betrug 85%, die 5-Jahres-Wahrscheinlichkeit, eine Enukleation zu vermeiden, 72%. Die häufigsten Nebenwirkungen waren radiogene Optikusläsion (29%), Makulopathie (37%) und Strahlenretinopathie (32%). Bei Abschluss der Studie erreichten 34% der Patienten einen Visus von zumindest 0,5, 34% der Patienten hatten ein Sehvermögen von unter 0,1. Zusammenfassung Die Rutheniumtherapie ist unsere Methode der Wahl bei kleinen und mittelgroßen Tumoren der mittleren und äußeren Peripherie und des Ziliarkörpers mit einer maximalen Tumorhöhe von 6 mm. Ergänzend zu den von Lommatzsch ursprünglich angegebenen Indikationen können Ziliarkörpermelanome mit einer Basis von mehr als 3 Stunden alternativ mit Ruthenium-106-Applikatoren behandelt werden (durch Shiften der Applikatoren). Background to investigate the clinical course, sequelae and visual function of uveal melanomas treated with Ruthenium 106 brachytherapy. Patients and method 47 patients who underwent Ruthenium 106 brachytherapy between 1985 and 2000 were evaluated using Kaplan Meier statistical method. Mean follow up interval was 22 months (range 8–152 months). Results Local tumor control rate was 85%, 5 years possibility to avoid enucleation was 72%. The most important sequelae were radiation optic neuropathy (29%), maculopathy (37%) and radiation retinopathy (32%). After terminating the study 34% of the patients achieved a visual acuity of 20/40 and more, another 34% had a visual function of 20/200 and lower. Conclusion Ruthenium 106 brachytherapy is our method of choice in small to medium sized uveal melanomas and a maximum tumor prominence of 6 mm. tumors have to be located in the midperiphery and outer periphery of the fundus including the ciliary body. In addition to the indications introduced by Lommatzsch we treated ciliary body melanomas with a tumor base more than 3 clock hours (by shifting the plaque) as an alternative therapy to enucleation.
Jacob Peer - One of the best experts on this subject based on the ideXlab platform.
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Ruthenium 106 brachytherapy
Developments in ophthalmology, 2012Co-Authors: Jacob PeerAbstract:Brachytherapy is the most common method for treating uveal melanoma, and currently the Ruthenium-106 (Ru-106) and iodine-125 (I-125) applicators are the most frequently used. Ru-106 applicators were introduced by Prof. Peter Lommatzsch in the 1960s, and since then have been used widely by many ocular oncologists, mainly in Europe. The Ru-106 isotope is a beta ray (electron) emitter, and as such it has a limited depth of penetration. This is the reason why many experts use Ru-106 applicators for tumors with a maximal thickness of up to 7.0 mm, although others use it successfully for thicker tumors. The Ru-106 applicators are manufactured commercially and have a half-life of about 1 year. Ru-106 brachytherapy for uveal melanoma provides excellent local control rates and eye preservation with a relatively low recurrence rate. The main advantage of Ru-106 over other isotopes is the better preservation of vision in the treated eye, and less damage to the healthy parts of the eye due to its limited range of radiation. This can also be achieved by positioning the Ru-106 plaque eccentrically, away from the macula and optic nerve head. Ru-106 brachytherapy can be used in combination with other methods of treatment of uveal melanoma, such as local resection or transpupillary thermotherapy, and is sporadically combined with other isotopes, such as gamma-emitting cobalt-60 and I-125.
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Ruthenium 106 plaque brachytherapy for thick posterior uveal melanomas
British Journal of Ophthalmology, 2009Co-Authors: Nadia Kaiserman, Igor Kaiserman, Karen Hendler, Shahar Frenkel, Jacob PeerAbstract:Aims: Ruthenium-106 brachytherapy is an effective method for treating small to medium uveal melanomas. The purpose of this study was to examine its effectiveness and safety in the management of thick posterior uveal melanoma (apical height ⩾8.0 mm) and to compare it with enucleation. Methods: 126 consecutive patients with thick uveal melanoma were included. 63 patients treated with Ruthenium-106 brachytherapy were compared with 63 patients treated with enucleation. The main outcome measures were visual acuity, eye retention, local recurrence, metastases, all-cause mortality and melanoma-related mortality. Results: Patients treated with brachytherapy were significantly younger and had significantly smaller tumours, compared with patients treated with enucleation. Tumour thickness in the brachytherapy group was 9.3 (SD 0.9) mm compared with 12.2 (1.9) mm in the enucleation group. The 5- and 10-year melanoma-related mortality was 20.5% and 46.2% for brachytherapy patients and 28.1% and 44.0% for enucleation patients (p = 0.6 and p = 0.9). When comparing 15 brachytherapy with 15 matched enucleation patients, the 5-year melanoma-related mortalities were similar, 28.6% and 33.3% respectively (p = 0.7). Complications associated with brachytherapy included tumour regrowth (n = 15), scleral melt (n = 3), neovascular glaucoma (n = 5) and vitreous haemorrhage (n = 3). In the brachytherapy group, no significant difference in survival was noted between patients who did and did not develop local recurrence (p = 0.9). Of the eyes that were initially treated with brachytherapy, 71.4% were saved from enucleation. Of these, 70.8% had a final visual acuity of 20/200 or better. Conclusions: Ruthenium-106 brachytherapy is an alternative to enucleation in some thick posterior uveal melanomas.
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changes in ultrasound findings in posterior uveal melanoma after Ruthenium 106 brachytherapy
Ophthalmology, 2002Co-Authors: Igor Kaiserman, Irene Anteby, Itay Chowers, Eytan Z Blumenthal, Iris Kliers, Jacob PeerAbstract:Abstract Purpose To analyze the postbrachytherapy ultrasonographic dynamics of uveal melanoma tumor height and internal reflectivity. Design Prospective, comparative, observational case series. Participants One hundred forty-seven patients (147 eyes) with posterior uveal melanoma having a mean age of 61 years (range, 29–97 years) who were treated with Ruthenium 106 brachytherapy. Methods Patients were followed-up with ultrasonography using both A and B modes of standardized echography every 6.7 ± 0.3 months (mean ± standard error of the mean) for a total of 1001 ultrasound examinations. On average, each patient was examined 5.8 times (range, 3–17 times). The echographic parameters included tumor base size, height, internal reflectivity, regularity, vascularity, and extra-scleral extension. To compare the response of tumors of different sizes, each tumor was standardized to its initial size at brachytherapy. Main outcome measures The dynamics of the tumor height and internal reflectivity. Results At the time of brachytherapy, the mean height of the tumors was 5.2 mm (range, 2.2–11.8 mm). After brachytherapy, 142 tumors (96.6%) responded by a decrease in height. The decrease in height was at an initial rate of approximately 3% per month. Most of the tumors did not regress entirely; rather, their height stabilized on a constant value (on average 61% of the initial height) after approximately 18 to 24 months. The decrease in height after brachytherapy was best fitted by the sum of a first order exponential decay and a constant (h = 61 + 35∗e −0.12t , in which t=time in months). The half-life of the decay was 5.8 months. Large tumors (>8 mm) had a faster initial decrease in height, and stabilized on a lower percentage of their initial height (50%) compared with small tumors (70%). Thus, the half-life of the height exponential decay was 5.3 months for small tumors (2–4 mm) and 3.3 months for the large tumors (>8 mm). Internal reflectivity increased from a mean of 40% before therapy to 70% after 2 years. The dynamics of the reflectivity were best fitted with the function: f=45 + 24(1-e −0.09t ). Larger tumors, which initially had lower internal reflectivity, presented with a slower increase in internal reflectivity (t 12 = 8.7 months) compared with smaller tumors (t 1/2 = 5 months). Conclusions The postbrachytherapy ultrasonographic dynamics of uveal melanomas resemble a function composed of the sum of a constant and a first order exponent, suggesting the possible existence of two components (cell populations), one unaffected by brachytherapy and the other a radiosensitive population that reacts to brachytherapy in an exponential decay. An exponential decay can imply that the postbrachytherapy death of each tumor cell is a stochastic Markovian process that is independent of the death of other tumor cells.
Gre P M Luyten - One of the best experts on this subject based on the ideXlab platform.
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Ruthenium 106 brachytherapy for iris and iridociliary melanomas
British Journal of Ophthalmology, 2018Co-Authors: Marina Marinkovic, Nanda Horeweg, M S Laman, Jaco C Bleeker, M Ketelaars, Femke P Peters, Gre P M Luyten, Carien L CreutzbergAbstract:Background and purpose To evaluate Ruthenium-106 (Ru106) brachytherapy as eye-conserving treatment of iris melanomas (IMs) and iridociliary melanomas (ICMs). Materials and methods Eighty-eight patients received Ru106 brachytherapy between 2006 and 2016. Primary outcome was local control, and secondary outcomes were metastasis, survival, eye preservation, complications and visual acuity (VA). Results Overall median follow-up was 36 months. Of 88 patients, 58 (65.9%) had IM and 30 (34.1%) had ICM. ICM were on average larger and more advanced than IM. Local failure-free survival at 3 years was 98.9% (SE 1.2%). Metastasis-free survival was 98.2% (SE 1.8%) at 3 years; no deaths due to melanoma occurred during follow-up. Eye preservation rate was 97.7%. Treatment-related toxicities were mostly mild and observed in 80.7% of the patients. Common toxicities were worsening of pre-existing or new cataract (51.1%), dry eyes (29.5%) and glaucoma (20.5%). VA was not affected by Ru106 brachytherapy, with only 2.3% having VA Conclusions Ru106 for IM and ICM yielded excellent local control (98.9%) and eye preservation (97.7%). Toxicities were common, but mostly mild and transient. Moreover, Ru106 did not affect visual acuity.
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Ruthenium 106 brachytherapy for choroidal melanoma without transpupillary thermotherapy similar efficacy with improved visual outcome
European Journal of Cancer, 2016Co-Authors: Marina Marinkovic, Nanda Horeweg, M S Laman, Jaco C Bleeker, M Ketelaars, Femke P Peters, Marta Fiocco, Linda W Sommers, Gre P M LuytenAbstract:Abstract Purpose To evaluate efficacy and toxicity of two different protocols for eye-conserving treatment of patients with small to intermediate-sized choroidal melanomas; the current Ruthenium-106 (Ru106) brachytherapy protocol and the preceding protocol of Ru106-brachytherapy with transpupillary thermotherapy (Ru106/TTT). Methods and materials Long-term outcomes of 449 consecutive patients, of whom 196 (43.6%) treated using Ru106/TTT and 253 (56.3%) treated using Ru106, were compared in terms of local control, survival, eye preservation and visual outcome. Results Median follow-up was 82.8 months. Patients in the Ru106-group had smaller, less centrally located tumours and better pre-treatment visual acuity (VA). Five-year cumulative incidence of local failure was 11.2% for Ru106/TTT and 5.2% for Ru106, which was not statistically significant after correction for differences in baseline characteristics (hazard ratio for Ru106 = 0.57, p = 0.14). Cumulative incidence of distant metastases was 11.2 versus 6.2%, and cumulative incidence of cause-specific death was 22.4 versus 5.5% for Ru106/TTT and Ru106 respectively. Enucleation was performed in 9.2 versus 4.0% for Ru106/TTT versus Ru106; 5.1 versus 3.2% for local failure and 2.6 versus 0.8% for complications. At one year of follow-up, significantly more patients had lost useful vision (VA Conclusions Both the current Ru106 and the preceding Ru106/TTT-protocols provided excellent tumour control, cosmetic and functional eye preservation and vital prognosis. The Ru106-protocol yielded prolonged preservation of VA and should be regarded the current standard of treatment.
Peter Winkler - One of the best experts on this subject based on the ideXlab platform.
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tumor parameters predict the risk of side effects after Ruthenium 106 plaque brachytherapy of uveal melanomas
PLOS ONE, 2017Co-Authors: Lisa Tarmann, Werner Wackernagel, M Schneider, Peter Winkler, Domagoj Ivastinovic, G LangmannAbstract:BACKGROUND: To report on radiation-related side effects and complications after Ruthenium-106 plaque brachytherapy of uveal melanomas. METHODS: Medical records of 143 eyes with uveal melanoma, treated by Ruthenium-106 brachytherapy between 1997 and 2012 at a single center, were analyzed. We evaluated the occurrence of radiation-related side effects on the anterior and posterior segment of the eye. The influence of patient, tumor and treatment parameters on outcome was analyzed by multivariate time to event analysis considering competing risks. RESULTS: The median overall follow-up was 37.9 months. After treatment, the estimated risk at 12, 24 and 48 months for developing anterior segment complications was 25.3%, 37.5% and 50.3% for cataract formation and 5.4%, 6.4% and 8.1% for secondary glaucoma, respectively. The estimated risk for the occurrence of posterior segment complications 12, 24 and 48 months after treatment was 3.1%, 6.7% and 18.3% for radiation retinopathy, 18.3%, 27.1% and 42.6% for radiation maculopathy and 16.5%, 21.0% and 32.8% for radiation neuropathy, respectively. The risk of an increase in retinal detachment after treatment was 14.7%, 14.7% and 17.4% at 12, 24 and 48 months, respectively. The risk of vitreous hemorrhage occurring after treatment was 6.2%, 8.1% and 12.7%, and the risk of tumor vasculopathy was 15.4%, 17.4% and 19.0%. Scleral necrosis was observed in one patient. CONCLUSION: Radiation-related side effects and complications are common among patients treated with Ruthenium brachytherapy for uveal melanoma. However, the risk for those largely depends on individual tumor parameters. Before treatment, patients should be informed of their specific risks to develop various side effects. Patient information before treatment should cover not only general information about the treatment and possible complications and side effects but should also give details on the specific risks of the patient in her individual situation. This also includes elucidating the patient's individual resources and expectations and her willingness for long-term regular follow-up examinations and secondary adjunct treatments.
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Ruthenium 106 plaque brachytherapy for uveal melanoma
British Journal of Ophthalmology, 2015Co-Authors: Lisa Tarmann, Werner Wackernagel, Alexander Avian, Christoph Mayer, M Schneider, Peter Winkler, G LangmannAbstract:Background To report on local tumour control, eye preservation and visual outcome after Ruthenium-106 brachytherapy for uveal melanoma. Methods Medical records of 143 eyes with uveal melanoma, treated by Ruthenium-106 brachytherapy between 1997 and 2012 at one single centre, were included. Primary outcome measures were local tumour control, eye preservation and visual outcome. The influence of patient, tumour and treatment parameters on outcome was analysed by time to event analysis and competing risk regression. Results The median overall follow-up was 37.9 months. Tumour control: recurrent tumour growth was observed in 17 patients. The estimated local tumour recurrence rate at 12, 24 and 48 months after irradiation was 3%, 8.4% and 14.7%, respectively. The only significant risk factors for tumour recurrence were age (p=0.046) and reduced initial visual acuity (VA, p=0.045). No significant difference could be shown for tumour size or tumour category (T1–T2 vs T3–T4), and for any other tumour or treatment parameters (including combined transpupillary thermo-therapy (TTT)). Eye preservation: The likelihood of keeping the eye 12, 24 and 48 months after irradiation was 97.7%, 94.7% and 91.8%, respectively. Most significant risk factors for secondary enucleation were initial VA (p Vision The chances of keeping VA of 20/200 or better at 1, 2 and 5 years after treatment were 86.4%, 80.8% and 61.7%, respectively. Patients receiving sandwich-TTT showed significantly worse visual outcomes. Conclusions Ruthenium-106 brachytherapy appears to be a useful treatment regarding tumour control, eye preservation and visual function. Adjunct sandwich therapy resulted in worse visual outcome.
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Impact of Dose Rate on Clinical Course in Uveal Melanoma after Brachytherapy with Ruthenium-106
Strahlentherapie und Onkologie, 2007Co-Authors: Georg Mossböck, Peter Winkler, Thomas Rauscher, Karin S. Kapp, G LangmannAbstract:Background and Purpose: It has been suggested that the actual dose rate of an irradiating source may be a distinct influencing factor for the biological effect after brachytherapy with Ruthenium-106 for uveal melanoma. The purpose of this study was to investigate a hypothesized impact of the dose rate on the clinical and echographic course after brachytherapy. Patients and Methods: In total, 45 patients were included in this retrospective study. According to the actual dose rate, two groups were defined: group 1 with a dose rate < 4 Gy/h and group 2 with a dose rate ≥ 4 Gy/h. Regarding age, tumor height, basal diameter, scleral and apical dose, differences between the groups were not significant. Clinical parameters, including early and late side effects, and echographic courses were compared. Results: A significantly lower metastatic rate was found in group 2. Using univariate Cox proportional hazards regression, only dose rate predicted metastatic spread significantly (p < 0.05), while in a multivariate analysis, using age at the time of treatment, greatest tumor height and greatest basal diameter as covariates, the variable dose rate was of borderline significance (p = 0.077). Patients in group 2 had more early side effects and more pronounced visual decline, but these differences were of borderline significance with p-values of 0.072 and 0.064, respectively. Conclusion: These data suggest that a higher dose rate may confer a lower risk for metastatic spread, but may be associated with more side effects and more pronounced visual decline. Hintergrund und Ziel: Es wurde vermutet, dass die Dosisrate einer Strahlenquelle einen maßgeblichen Faktor für den biologischen Effekt nach Brachytherapie mit Ruthenium-106 beim uvealen Melanom darstellt. Ziel dieser Studie war die Untersuchung des Einflusses der Dosisrate auf den klinischen und echographischen Verlauf nach Brachytherapie. Patienten und Methodik: Insgesamt wurden 45 Patienten in diese retrospektive Studie eingeschlossen. Entsprechend der Dosisrate zum Zeitpunkt der Brachytherapie wurden zwei Gruppen definiert: Gruppe 1 mit einer Dosisrate < 4 Gy/h und Gruppe 2 mit einer Dosisrate ≥ 4 Gy/h. Bezüglich des Alters, der Tumorhöhe, des basalen Durchmessers sowie der Sklerakontakt- und apikalen Dosis bestand kein signifikanter Unterschied zwischen den beiden Gruppen. Klinische Parameter inklusive früher und später Nebenwirkungen sowie der echographische Verlauf wurden verglichen. Ergebnisse: Es fand sich eine signifikant niedrigere Metastasierungsrate in Gruppe 2. Mit der univariaten Cox-Regression zeigte sich nur für die Dosisrate ein signifikanter Zusammenhang (p < 0,05), während der Zusammenhang in der multivariaten Analyse mit Alter, größter Tumorhöhe und größtem Tumordurchmesser als Kovariablen grenzwertig war (p = 0,077). Patienten der Gruppe 2 hatten eine höhere Rate an frühen Nebenwirkungen und einen größeren Visusverlust, wobei die Unterschiede grenzwertig signifikant waren (p = 0,072 bzw. p = 0,064). Schlussfolgerung: Diese Daten lassen vermuten, dass eine höhere Dosisrate ein niedrigeres Metastasierungsrisiko aufweist, aber mit einer höheren Rate an Nebenwirkungen und größerem Visusverlust assoziiert ist.
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impact of dose rate on clinical course in uveal melanoma after brachytherapy with Ruthenium 106
Strahlentherapie Und Onkologie, 2007Co-Authors: Georg Mossböck, Peter Winkler, Thomas Rauscher, Karin S. Kapp, G LangmannAbstract:Background and Purpose: It has been suggested that the actual dose rate of an irradiating source may be a distinct influencing factor for the biological effect after brachytherapy with Ruthenium-106 for uveal melanoma. The purpose of this study was to investigate a hypothesized impact of the dose rate on the clinical and echographic course after brachytherapy. Patients and Methods: In total, 45 patients were included in this retrospective study. According to the actual dose rate, two groups were defined: group 1 with a dose rate < 4 Gy/h and group 2 with a dose rate ≥ 4 Gy/h. Regarding age, tumor height, basal diameter, scleral and apical dose, differences between the groups were not significant. Clinical parameters, including early and late side effects, and echographic courses were compared. Results: A significantly lower metastatic rate was found in group 2. Using univariate Cox proportional hazards regression, only dose rate predicted metastatic spread significantly (p < 0.05), while in a multivariate analysis, using age at the time of treatment, greatest tumor height and greatest basal diameter as covariates, the variable dose rate was of borderline significance (p = 0.077). Patients in group 2 had more early side effects and more pronounced visual decline, but these differences were of borderline significance with p-values of 0.072 and 0.064, respectively. Conclusion: These data suggest that a higher dose rate may confer a lower risk for metastatic spread, but may be associated with more side effects and more pronounced visual decline.
J. Faulborn - One of the best experts on this subject based on the ideXlab platform.
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Über den Stellenwert der Ruthenium-106- Brachytherapie bei der Therapie von Aderhautmelanomen
Spektrum der Augenheilkunde, 2002Co-Authors: G Langmann, G. Mosböck, G. Stücklschwaiger, K. Müllner, H. Lechner, J. FaulbornAbstract:Die an der Universitäts-Augenklinik Graz seit ihrer Einführung im Jahr 1985 mit Ruthenium 106 behandelten Aderhautmelanome wurden in Hinblick auf klinischen Verlauf, Komplikationen und Sehschärfe untersucht. Patienten und Methode In Form einer retrospektiven Studie wurden 47 Patienten, die zwischen 1985 und 2000 mit Ruthenium 106 behandelt wurden (medianer Nachbeobachtungszeitraum 22 Monate [8–152 Monate]), mittels Kaplan Meiers statistischer Evaluierung untersucht. Ergebnisse Die lokale Tumorkontrollrate betrug 85%, die 5-Jahres-Wahrscheinlichkeit, eine Enukleation zu vermeiden, 72%. Die häufigsten Nebenwirkungen waren radiogene Optikusläsion (29%), Makulopathie (37%) und Strahlenretinopathie (32%). Bei Abschluss der Studie erreichten 34% der Patienten einen Visus von zumindest 0,5, 34% der Patienten hatten ein Sehvermögen von unter 0,1. Zusammenfassung Die Rutheniumtherapie ist unsere Methode der Wahl bei kleinen und mittelgroßen Tumoren der mittleren und äußeren Peripherie und des Ziliarkörpers mit einer maximalen Tumorhöhe von 6 mm. Ergänzend zu den von Lommatzsch ursprünglich angegebenen Indikationen können Ziliarkörpermelanome mit einer Basis von mehr als 3 Stunden alternativ mit Ruthenium-106-Applikatoren behandelt werden (durch Shiften der Applikatoren). Background to investigate the clinical course, sequelae and visual function of uveal melanomas treated with Ruthenium 106 brachytherapy. Patients and method 47 patients who underwent Ruthenium 106 brachytherapy between 1985 and 2000 were evaluated using Kaplan Meier statistical method. Mean follow up interval was 22 months (range 8–152 months). Results Local tumor control rate was 85%, 5 years possibility to avoid enucleation was 72%. The most important sequelae were radiation optic neuropathy (29%), maculopathy (37%) and radiation retinopathy (32%). After terminating the study 34% of the patients achieved a visual acuity of 20/40 and more, another 34% had a visual function of 20/200 and lower. Conclusion Ruthenium 106 brachytherapy is our method of choice in small to medium sized uveal melanomas and a maximum tumor prominence of 6 mm. tumors have to be located in the midperiphery and outer periphery of the fundus including the ciliary body. In addition to the indications introduced by Lommatzsch we treated ciliary body melanomas with a tumor base more than 3 clock hours (by shifting the plaque) as an alternative therapy to enucleation.
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uber den stellenwert der Ruthenium 106 brachytherapie bei der therapie von aderhautmelanomen
Spektrum Der Augenheilkunde, 2002Co-Authors: G Langmann, G. Mosböck, G. Stücklschwaiger, K. Müllner, H. Lechner, J. FaulbornAbstract:Die an der Universitats-Augenklinik Graz seit ihrer Einfuhrung im Jahr 1985 mit Ruthenium 106 behandelten Aderhautmelanome wurden in Hinblick auf klinischen Verlauf, Komplikationen und Sehscharfe untersucht.
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Transpupillare Thermotherapie (TTT), Ruthenium 106 Brachytherapie oder Leksell® Gamma Knife Radiochirurgie. Eine Standortbestimmung
Spektrum der Augenheilkunde, 2001Co-Authors: G Langmann, K. Müllner, H. Lechner, G. Mossböck, G. Papaefthymiou, Kh. Feichtinger, G. Pendl, J. FaulbornAbstract:Die Publikation soll den Stellenwert von neuen Therapiekonzepten wie transpupillare Thermotherapie (TTT) oder einzeitige Leksell Gamma Knife Radiochirurgie vor dem Hintergrund einer etablierten Therapie wie der Ruthenium 106 Brachytherapie beleuchten. Patienten und Methodik Von den seit 1985 bulbuserhaltend an der Univ.-Augenklinik Graz behandelten Patienten wurden ausgewertet: 58 Patienten mit kleinen und mittelgroßen Aderhautmelanomen und Ruthenium 106 Brachytherapie, 60 Patienten mit mittelgroßen und großen Melanomen und Leksell Gamma Knife® Radiochirurgie und 28 Patienten mit transpupillarer Thermotherapie (TTT). Ergebnisse Nach Ruthenium 106 Brachytherapie konnten 43/47 Augen erhalten werden, 2 Augen mussten auf Grund eines Rezidivs enukleiert werden, nach Leksell Gamma Knife® Therapie wurden 51/60 Augen erhalten, 4 wurden auf Grand eines Rezidivs und 5 wegen eines hämorrhagischen Glaukoms entfernt. Nach Thermotherapie wurden 23/28 Augen erhalten, 5 mussten auf Grund eines Rezidivs enukleiert werden. Diskussion Die transpupillare Thermotherapie ist bei juxtapapillären Tumoren und einer maximalen Prominenz von 3 mm Therapie der Wahl an unserer Klinik, die Ruthenium 106 Brachytherapie bei Tumoren der mittleren Peripherie und des Ziliarkörpers und einer Prominenz bis zu 5 (6) mm, wir ziehen die Gamma Knife Radiochirurgie bei makulären und juxtamakulären Tumoren bzw. Tumoren bis zu einer maximalen Prominenz von 10 mm anderen Therapiekonzepten vor. Die Ergebnisse der einzelnen Therapien sind nur bedingt miteinander vergleichbar, da bei der Thermotherapie flache Tumore in zentraler Lokalisation, bei der Leksell Gamma Knife Therapie z. T. hoch prominente Tumoren mit großen Tumorvolumina behandelt werden. This paper deals with new globe preserving therapies like transpupillary thermotherapy (TTT) and single fraction Leksell® Gamma Knife radiosurgery as well as widly accepted therapies like Ruthenium 106 brachytherapy. Patients and methods Since 1985 58 patients suffering from small to medium sized uveal melanomas have been treated with Ruthenium 106, 60 patients underwent Leksell Gamma Knife Radiosurgery and 28 mainly small posteriorly located uveal melanomas were treated with transpupillary thermotherapy (TTT). Results Ruthenium 106 brachytherapy could achieve globe preservation in 43 out of 47 eyes, in 60 eyes treated with the Leksell® Gamma Knife as an alternative therapy to enucleation 51 could be retained, 5 eyes were removed due to neovascular glaucoma and 4 eyes due to recurrant tumor growth. After thermotherapy 23/28 globes could be preserved, 5 eyes had to be enucleated due to regrowth. Discussion Transpupillary thermotherapy (TTT) is our treatment of choice in small melanomas of the posterior pole up to 3 mm prominence, we prefer Ruthenium 106 in medium sized tumors located in the midperiphery of the fundus and ciliary body. Single fraction Leksell Gamma Knife® Radiosurgery is our treatment of choice in macular melanomas and tumors with a maximum tumor prominence of 10 mm. These different therapeutic modalities can hardly be compared as tumors of different sizes (volumes) and locations had been treated.
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transpupillare thermotherapie ttt Ruthenium 106 brachytherapie oder leksell gamma knife radiochirurgie eine standortbestimmung
Spektrum Der Augenheilkunde, 2001Co-Authors: G Langmann, K. Müllner, H. Lechner, G. Mossböck, G. Papaefthymiou, Kh. Feichtinger, G. Pendl, J. FaulbornAbstract:Die Publikation soll den Stellenwert von neuen Therapiekonzepten wie transpupillare Thermotherapie (TTT) oder einzeitige Leksell Gamma Knife Radiochirurgie vor dem Hintergrund einer etablierten Therapie wie der Ruthenium 106 Brachytherapie beleuchten.
