RADIATION INDUCED Carlo Mosci Ocular Oncology Service Galliera Hospital Genova Italy (www.galliera.it) "Working Day - Radiation Side Effects" carlo.mosci@galliera.it
RADIATION INDUCED Different treatment for different ocular melanoma: radiotherapy surgery combined therapy Each treatment has a specific indication, controindication, risks and complications
TAILORED THERAPY Following the needs, wishes, fears and personal situation of the patient Ocular melanoma could give an important visual and aestethic handicap (enucleation)
RADICAL TREATMENT Iridectomy Iriciclectomy Choroidal resection (Endoresection) ENUCLEATION Exenteration
CONSERVATIVE TREATMENT Observation RADIOTHERAPY TTT Combined treatment
CONSERVATIVE TREATMENT Radioactive plaque Ruthenium / brachitherapy Iodine
CONSERVATIVE TREATMENT External radiotherapy (teletherapy) 9 0 5 0 2 0 0 % of dose % of dose Proton beam 9 0 5 0 2 0 0
PROTON BEAM TREATMENT Plan therapy
CONSERVATIVE TREATMENT Following the Collaborative Ocular melanoma Study (COMS) the therapeutic option for choroidal melanoma have shifted from enucleation to radiotherapy : the survival rate has been found to be similar
CONSERVATIVE TREATMENT - observation -RADIOTHERAPY (70%) -TTT -combined treatment
RADIATION SIDE EFFECTS Double face of the same coin: Efficacy of the radiation on the tumor Complications: damage caused by the radiation to the tissue around the tumor
RADIATION SIDE EFFECTS NEOVASCULAR GLAUCOME PRIMARY CAUSE OF ENUCLEATION
RISK FACTORS FOR TUMOR SIZE PROXIMITY TO THE OPTIC DISC/MACULA UVEAL INVOLMENT ANTERIOR TO THE EQUATOR PRESENCE OF SEROUS RETINAL DETACHMENT
RISK FACTORS FOR TUMOR SIZE PROXIMITY TO THE OPTIC DISC/MACULA UVEAL INVOLMENT ANTERIOR TO THE EQUATOR PRESENCE OF SEROUS RETINAL DETACHMENT
RISK FACTORS FOR TUMOR SIZE PROXIMITY TO THE OPTIC DISC/MACULA UVEAL INVOLMENT ANTERIOR TO THE EQUATOR PRESENCE OF SEROUS RETINAL DETACHMENT
RISK FACTORS FOR TUMOR SIZE PROXIMITY TO THE OPTIC DISC/MACULA UVEAL INVOLMENT ANTERIOR TO THE EQUATOR PRESENCE OF SEROUS RETINAL DETACHMENT
RISK FACTORS FOR TUMOR SIZE PROXIMITY TO THE OPTIC DISC/MACULA UVEAL INVOLMENT ANTERIOR TO THE EQUATOR PRESENCE OF SEROUS RETINAL DETACHMENT
RISK FACTORS FOR TUMOR SIZE PROXIMITY TO THE OPTIC DISC/MACULA UVEAL INVOLMENT ANTERIOR TO THE EQUATOR PRESENCE OF SEROUS RETINAL DETACHMENT
ETIOPATOGENESIS OF RADIATION RETINOPATHY ANGIOGENIC FACTORS TUMOR RADIATION INDUCED INFLAMMATION RETINAL ISCHEMIA FOLLOWING SEROUS RETINAL DETACHMENT OR RETINAL TUMOR INVASION
RISK FACTORS FOR Diabetes Chemiotherapy Radiotherapy modality: Teletherapy: fractionation Brachyterapy: type of radiation isotope Total dose to the eye Total dose to optic disc Retinal detachment
RADIATION INDUCED PROTON BEAM (bigger tumors): 7 47% PLAQUE RADIOTHERAPY (smaller tumors): 4 23%
TREATMENT OF SURGERY FOR GLAUCOMA SURGERY FOR THE TUMOR (ENDO/ESORESECTION) ANTI-VEGF PREVENTION
TREATMENT OF IS THERE A RESIDUAL VISUAL FUNCTION? NO YES IS THE FUNDUS EXPLORABLE? NO YES ENUCLEATION MEDICAL AND / OR SURGICAL TREATMENT
TREATMENT OF PANRETINAL PHOTOCOAGULATION PHARMACOLOGICAL TREATMENT TOPICAL CORTICOSTEROIDS CYCLOPLEGIC AGENTS OSMOTIC AGENTS
TREATMENT OF SURGICAL TREATMENT TRABECULECTOMY AQUEOUS DRAINAGE IMPLANTS CYCLODESTRUCTION ANTI-VEGF
RADIATION INDUCED After what we have discussed, two final questions: 1) is it possible a screening to treat smaller intraocular tumors? 2) do we have to review our indication of radiotherapy treatment? THANK YOU FOR YOUR ATTENTION