Cyberknife Radiosurgery for Uveal Melanoma

Transcription

1 Cyberknife Radiosurgery for Uveal Melanoma Kirsten Eibl, Alexander Muacevic, Anselm Kampik Cyberknife Center Munich-Großhadern in cooperation with the University Hospital of the University Munich

2 Uveal Melonama 70% of all primary ocular malignancies Incidence: 6 7 / % white population caucasian race light skin color blond hair blue eyes 5-year survival rate: 80% with S / RT Singh AD Ophthalmology, 2004

3 Enucleation Radiotherapy/Radiosurgery Brachytherapy (Ru 106, I 125, Pd 103 ) Proton Gamma Knife Endo/Exoresection +/- CRT Problem: Large Tumors

4 Mortality Successful treatment of primary Metastases 3 years after initial diagnosis > 30 years possible 1 mortality due to systemic metastases after 5, 15, 35 years: 62%, 90%, 98% 2 Tumor specific mortality after 5 years 3,4 10% medium sized tumors (max. height mm) 31% - 35% large size tumors (max. height > 8 mm) 1 Chisholm JF. A long-term follow-up on malignant melanoma of the choroid based on the Terry and Johns series. Am J Ophthalmol 1953;36: Kujala E, Ma kitie T, Kivela T. Very long term prognosis of malignant uveal melanoma. Invest Ophthalmol Vis Sci 2003;44: The Collaborative Ocular Melanoma Study Group. Initial mortality findings. COMS report no. 10. Am J Ophthalmol 1998;125: The Collaborative Ocular Melanoma Study Group. Initial mortality findings. COMS report no. 18. Arch Ophthalmol 2001;119:

5 Inclusion criteria radiosurgery (tumor height > 6 mm) (tumor base > 19 mm) location not suitable for Ru106 brachytherapy

6 Treatment protocol outpatient procedure retrobulbar anesthesia for complete akinesia of the globe within the orbit no muscle sutures, no sclero-corneal suction device follow up ultrasound every 3 months, MRI scan 6 months (first year) Ultrasound/MRI liver!

7 Retrobulbar Anesthesia

8 Retrobulbar Anesthesia 10 min. MRI Scan 20 min. CT Scan (mask) 10 min. Computerized Planning Treatment 20 min. 60 min. X

9 Eye globe shift

10 Munich Eye globe shift DO NOT REPRODUCE IN ANY MANNER Presented June 19, 2012

11 Munich Treatment DO NOT REPRODUCE IN ANY MANNER f/u 8 months Presented June 19, 2012

12 age 64 years (median) (28 90 years) 198

13 Tumor height Median 7 mm (4,4 mm; 8,9 mm) * Median 5 mm (3,1 mm; 7,7 mm) Max tumor height [mm] * p< 0,05

14 Reflectivity * p< 0,05 * Median reflectivity [%] median 50% (40 %; 60 %) median 70 % (60 %; 76 %) Reflectivity before SRS [%] Reflectivity after SRS [%]

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17 Eye preservation

18 Eye loss 8 patients Location Max. Prom. [mm] Time to ENU [months] Reason for ENU 85 CK-MM peripher 4,5 16 Sclera breakthrough 59 AH-/CK-MM peripher 9,8 21 tumor growth 52 AH-/CK-MM peripher 8,4 6 tumor growth 59 AH-MM mittelperipher 9,8 12 tumor growth 80 AH-MM mittelperipher 7,1 23 lateral growth 39 AH-MM mittelperipher 4, Tumor 43 AH-MM mittelperipher 3,5 10 lateral growth 79 AH-MM parapapillär 5,4 13 orbital inflammation

19 Possible Complications bleeding into vitreus body (n = 8) secondary glaucoma (n = 5) loss of visual acuity (Visus > 20/200 in 27 patients!)

20 Tumor Necrosis

21 Bleeding Complication treatment 3 months post CK 4 months post CK

22 Munich CK DO NOT REPRODUCE IN ANY MANNER 12 months f/u Presented June 19, 2012

23 Visual Acuity Munich improved: 4% unchanged: 28% reduced: 57% nulla lux: 11%

24 81 years, location: periphery Max. tumor height: 10.9 mm reflectivity: 36 % visual acuity: CF

25 81 years, follow up: 9 months Max. tumor height: 6.9 mm reflectivity: 62 % visual acuity: 20/70

26 48 years, location: periphery Max. tumor height: 8.2 mm Reflectivity: 45 % visual acuity: 20/20

27 48 years, follow up: 26 months Max. tumor height: 3.0 mm Reflectivity: 75 % visual acuity: 20/20

28 Conclusion Cyberknife treatment for uveal melanomas CYN = excellent tool for ocular radiosurgery high local control rates eye enucleation can be avoided in most cases cost effective compared to proton irradiation complete outpatient treatment can be performed in ~ 2.5 h team approach with ophthalmologists, radiation oncologist, physicists of critical importance!

29 Thank you for your attention! Name: Alex Muacevic, MD Address: Max Lebsche Platz 31 City, State, Zip: Munich, Country: Germany Phone Number: