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

• Published in: Cancers Vol. 14; no. 19; p. 4729
• Main Authors: Guberina, Maja, Sokolenko, Ekaterina, Guberina, Nika, Dalbah, Sami, Pöttgen, Christoph, Lübcke, Wolfgang, Indenkämpen, Frank, Lachmuth, Manfred, Flühs, Dirk, Chen, Ying, Hoffmann, Christian, Deuschl, Cornelius, Jabbarli, Leyla, Fiorentzis, Miltiadis, Foerster, Andreas, Rating, Philipp, Ebenau, Melanie, Grunewald, Tobias, Bechrakis, Nikolaos, Stuschke, Martin
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 28-09-2022; MDPI
• Subjects: Acuity; Care and treatment; Excision (Surgery); Eye; Immunoglobulins; Localization; Magnetic resonance imaging; Melanoma; Methods; Optic nerve; Patient outcomes; Patients; Planning; Radiation therapy; Radiosurgery; Retinal detachment; Side effects; Toxicity; Tumors; Vision; Germany
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14194729

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.