Abstract
BackgroundThis study retrospectively analyzed outcomes for patients undergoing gamma knife radiosurgery (GKR) for uveal melanoma (UM) and intraocular metastases.MethodsPatients who underwent GKR for UM or intraocular metastases between 1/1/1990 and 6/1/2015 at Mayo Clinic, Rochester, MN, USA, were retrospectively analyzed.ResultsEleven patients (11 eyes) had UM while seven patients (7 eyes) had intraocular metastases. Patients with UM were followed for a median of 19.74 ± 10.4 months. Visual acuity (VA) logMAR 0.30 ± 0.53 (Snellen 20/40) versus 0.40 ± 0.97 (Snellen 20/50), tumor thickness (5.30 ± 2.17 vs. 3.60 ± 2.32 mm), were not significantly different between preoperative and postoperative measurements, respectively. Nine percent (1/11) patients required enucleation. Subsequently, no patients experienced metastases. Patients with intraocular metastases were followed for a median of 6.03 ± 6.32 months. They did not have significant changes in VA (logMAR 0.30 ± 0.59 vs. 0.30 ± 1.57; Snellen 20/40 vs. 20/40) or tumor thickness (3.50 ± 1.36 vs. 1.30 ± 0.76 mm) postoperatively. Fourteen percent (1/7 patients) required enucleation. Complications experienced by patients with UM include radiation retinopathy (2/11), papillopathy (1/11), cystoid macular edema (1/11), vitreomacular traction (1/11), exudative retinal detachment (1/11). Patients with metastases had treatment complicated by recurrence (2/7). Dose to the margin, maximum dose of radiation, and clinical target volume did not correlate with post-procedural VA, risk of enucleation, or death in patients with either UM or patients with intraocular metastases.ConclusionsVisual outcomes were satisfactory for patients undergoing GKR without significant morbidity and without significant risk of enucleation or metastases.
Highlights
This study retrospectively analyzed outcomes for patients undergoing gamma knife radiosurgery (GKR) for uveal melanoma (UM) and intraocular metastases
Data obtained from patient records included: date of birth, sex, oncologic diagnosis, preoperative and postoperative visual acuity (VA), tumor thickness, largest-base dimension (LBD), intraocular pressure (IOP), additional ophthalmic procedures such as enucleation, and postprocedural complications such as radiation retinopathy
Maximum dose of radiation, and clinical target volume (CTV) did not correlate with post-procedural Visual acuity (VA), IOP, risk of enucleation, or death in patients with uveal metastases
Summary
This study retrospectively analyzed outcomes for patients undergoing gamma knife radiosurgery (GKR) for uveal melanoma (UM) and intraocular metastases. Ocular metastases are the most common intraocular malignancy, while uveal melanoma (UM) is the most common primary intraocular malignancy. Cancer treatments have evolved to prioritize the most effective minimally invasive treatments with the fewest side effects. For these reasons, proton beam therapy, plaque. Patients with known malignancy have an estimated incidence of ocular involvement at 4–12% in post-mortem studies [18, 21,22,23] and clinical apparent malignancies in 2.3–5% of patients [18, 21, 24].
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