Radiogenic Side Effects After Hypofractionated Stereotactic Photon Radiotherapy of Choroidal Melanoma in 212 Patients Treated Between 1997 and 2007

• Published in: International journal of radiation oncology, biology, physics Vol. 83; no. 1; pp. 121 - 128
• Main Authors: Dunavoelgyi, Roman, M.D, Dieckmann, Karin, M.D, Gleiss, Andreas, Ph.D, Sacu, Stefan, M.D, Kircher, Karl, M.D, Georgopoulos, Michael, M.D, Georg, Dietmar, Ph.D, Zehetmayer, Martin, M.D, Poetter, Richard, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier
• Subjects: Adult; Adverse side effects; Aged; Aged, 80 and over; Austria; Biological and medical sciences; BIOMEDICAL RADIOGRAPHY; BLOOD VESSELS; BRACHYTHERAPY; Cataract - etiology; CATARACTS; Choroid Neoplasms - pathology; Choroid Neoplasms - surgery; Choroidal melanoma; Cornea - radiation effects; Corneal Ulcer - etiology; Corneal Ulcer - pathology; Dermatology; Dose Fractionation; EPITHELIUM; Female; FLUORESCEIN; Follow-Up Studies; Glaucoma, Neovascular - etiology; Hematology, Oncology and Palliative Medicine; Humans; Hypofractionated stereotactic photon radiotherapy; Juxtapapillary tumors; LINEAR ACCELERATORS; Male; Medical sciences; Melanoma - pathology; Melanoma - surgery; MELANOMAS; Middle Aged; Optic Disk - radiation effects; PATIENTS; PHOTON BEAMS; PHOTONS; Photons - therapeutic use; PROTON BEAMS; Radiation Injuries - etiology; Radiation Injuries - pathology; Radiodermatitis - etiology; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery - adverse effects; Radiosurgery - methods; Retina - radiation effects; RUTHENIUM 106; SIDE EFFECTS; Time Factors; Tumors of the skin and soft tissue. Premalignant lesions; Uveitis - etiology; Uveitis - pathology; Young Adult; Austria; Hypofractionated stereotactic photon radiotherapy; Adverse side effects; Juxtapapillary tumors; Choroidal melanoma; Human; Toxicity; Radiosurgery; Choroid; Malignant tumor; Radiotherapy; Photon; Cancerology; Treatment; Malignant melanoma; Secondary effect; Cancer
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.06.1957

Purpose To evaluate side effects of hypofractionated stereotactic photon radiotherapy for patients with choroidal melanoma. Patients and Methods Two hundred and twelve patients with choroidal melanoma unsuitable for ruthenium-106 brachytherapy or local resection were treated stereotactically at the Medical University of Vienna between 1997 and 2007 with a Linac with 6-MV photon beams in five fractions with 10, 12, or 14 Gy per fraction. Examinations for radiogenic side effects were performed at baseline and every 3 months in the first 2 years, then every 6 months until 5 years and then once a year thereafter until 10 years after radiotherapy. Adverse side effects were assessed using slit-lamp examination, funduscopy, gonioscopy, tonometry, and, if necessary, fundus photography and fluorescein angiography. Evaluations of incidence of side effects are based on an actuarial analysis. Results One hundred and eighty-nine (89.2%) and 168 (79.2%) of the tumors were within 3 mm of the macula and the optic disc, respectively. The five most common radiotherapy side effects were retinopathy and optic neuropathy (114 cases and 107 cases, respectively), cataract development (87 cases), neovascular glaucoma (46 cases), and corneal epithelium defects (41 cases). In total, 33.6%, 38.5%, 51.2%, 75.5%, and 77.6% of the patients were free of any radiation retinopathy, optic neuropathy, cataract, neovascular glaucoma, or corneal epithelium defects 5 years after radiotherapy, respectively. Conclusion In centrally located choroidal melanoma hypofractionated stereotactic photon radiotherapy shows a low to moderate rate of adverse long-term side effects comparable with those after proton beam radiotherapy. Future fractionation schemes should seek to further reduce adverse side effects rate while maintaining excellent local tumor control.