Comparing Efficacy of Charged-particle Therapy with Brachytherapy in Treatment of Uveal Melanoma

Overview

Journal Eye (Lond)

Specialty Ophthalmology

Date 2024 Apr 2

PMID 38565600

Authors

Yu-Hsuan Tseng

Chia-An Hsu

Yu-Bai Chou

Affiliations

Soon will be listed here.

Abstract

Background: Uveal melanoma (UM) is the most common primary ocular tumour in adults. The most used eye-preserving treatments are charged-particle therapy (CPT) and brachytherapy. We performed a systematic review and meta-analysis to compare efficacies and complications of these two radiotherapies.

Methods: We searched EMBASE, PubMed, MEDLINE, and the Cochrane Library from January 2012 to December 2022. Two independent reviewers identified controlled studies comparing outcomes of CPT versus brachytherapy. Case series that utilize either treatment modality were also reviewed.

Results: One hundred fifty studies met the eligibility criteria, including 2 randomized control trials, 5 controlled cohort studies, and 143 case series studies. We found significant reduction in local recurrence rate among patients treated with CPT compared to brachytherapy (Odds ratio[OR] 0.38, 95% Confidence interval [CI] 0.24-0.60, p < 0.01). Analysis also showed a trend of increased risks of secondary glaucoma after CPT. No statistically significant differences were found in analyzing risks of mortality, enucleation, and cataract.

Conclusions: Our study suggested no difference in mortality, enucleation rate and cataract formation rate comparing the two treatments. Lower local recurrence rate and possibly higher secondary glaucoma incidence was noted among patients treated with CPT. Nevertheless, the overall level of evidence is limited, and further high-quality studies are necessary to provide a more definitive conclusion.

References

Barker C, Francis J, Cohen G, Marr B, Wolden S, McCormick B . (106)Ru plaque brachytherapy for uveal melanoma: factors associated with local tumor recurrence. Brachytherapy. 2014; 13(6):584-90. PMC: 4664055. DOI: 10.1016/j.brachy.2014.04.002. View

Isager P, Ehlers N, Urbak S, Overgaard J . Visual outcome, local tumour control, and eye preservation after 106Ru/Rh brachytherapy for choroidal melanoma. Acta Oncol. 2006; 45(3):285-93. DOI: 10.1080/02841860500468950. View

Diener-West M, Earle J, Fine S, Hawkins B, Moy C, Reynolds S . The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, II: characteristics of patients enrolled and not enrolled. COMS Report No. 17. Arch Ophthalmol. 2001; 119(7):951-65. DOI: 10.1001/archopht.119.7.951. View

Hauzinger J, Blatsios G, Haas G, Zehetner C, Velez-Escola L, Nowosielski Y . Proton beam radiation for iris melanoma: case series and review of literature. BMJ Open Ophthalmol. 2022; 6(1):e000683. PMC: 8705205. DOI: 10.1136/bmjophth-2020-000683. View

Char D, Kroll S, Phillips T, Quivey J . Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy. Ophthalmology. 2002; 109(10):1850-4. DOI: 10.1016/s0161-6420(02)01174-0. View

Kowal J, Markiewicz A, Debicka-Kumela M, Bogdali A, Jakubowska B, Karska-Basta I . Analysis of local recurrence causes in uveal melanoma patients treated with I brachytherapy - a single institution study. J Contemp Brachytherapy. 2020; 11(6):554-562. PMC: 6964341. DOI: 10.5114/jcb.2019.90985. View

Damato B, Kacperek A, Chopra M, Campbell I, Errington R . Proton beam radiotherapy of choroidal melanoma: the Liverpool-Clatterbridge experience. Int J Radiat Oncol Biol Phys. 2005; 62(5):1405-11. DOI: 10.1016/j.ijrobp.2005.01.016. View

Bolling J, Dagan R, Rutenberg M, Mamalui-Hunter M, Buskirk S, Heckman M . Treatment of Uveal Melanoma With Radioactive Iodine 125 Implant Compared With Proton Beam Radiotherapy. Mayo Clin Proc Innov Qual Outcomes. 2022; 6(1):27-36. PMC: 8715138. DOI: 10.1016/j.mayocpiqo.2021.10.002. View

Garcia-Alvarez C, Saornil M, Lopez-Lara F, Almaraz A, Munoz M, Frutos-Baraja J . Episcleral brachytherapy for uveal melanoma: analysis of 136 cases. Clin Transl Oncol. 2012; 14(5):350-5. DOI: 10.1007/s12094-012-0807-1. View

10.

Jancar B, Budihna M, Drnovsek-Olup B, Andrejcic K, Zupancic I, Pahor D . Prognostic factors of choroidal melanoma in Slovenia, 1986-2008. Radiol Oncol. 2016; 50(1):104-12. PMC: 4825345. DOI: 10.1515/raon-2015-0009. View

11.

Papakostas T, Lane A, Morrison M, Gragoudas E, Kim I . Long-term Outcomes After Proton Beam Irradiation in Patients With Large Choroidal Melanomas. JAMA Ophthalmol. 2017; 135(11):1191-1196. PMC: 5710395. DOI: 10.1001/jamaophthalmol.2017.3805. View

12.

Rospond-Kubiak I, Wroblewska-Zierhoffer M, Twardosz-Pawlik H, Kociecki J . Ruthenium brachytherapy for uveal melanoma - single institution experience. J Contemp Brachytherapy. 2018; 9(6):548-552. PMC: 5808002. DOI: 10.5114/jcb.2017.72606. View

13.

Wagner A, Chen A, Cook T, Faber D, Winward K, Sause W . Outcomes and control rates for I-125 plaque brachytherapy for uveal melanoma: a community-based institutional experience. ISRN Ophthalmol. 2014; 2014:950975. PMC: 3964762. DOI: 10.1155/2014/950975. View

14.

Caminal J, Padron-Perez N, Arias L, Masuet-Aumatell C, Gutierrez C, Piulats J . Transscleral resection without hypotensive anaesthesia vs iodine-125 plaque brachytherapy in the treatment of choroidal melanoma. Eye (Lond). 2016; 30(6):833-42. PMC: 4906458. DOI: 10.1038/eye.2016.49. View

15.

Mosci C, Mosci S, Barla A, Squarcia S, Chauvel P, Iborra N . Proton beam radiotherapy of uveal melanoma: Italian patients treated in Nice, France. Eur J Ophthalmol. 2009; 19(4):654-60. DOI: 10.1177/112067210901900421. View

16.

Sagoo M, Shields C, Mashayekhi A, Freire J, Emrich J, Reiff J . Plaque radiotherapy for choroidal melanoma encircling the optic disc (circumpapillary choroidal melanoma). Arch Ophthalmol. 2007; 125(9):1202-9. DOI: 10.1001/archopht.125.9.1202. View

17.

Meidenbauer K, Richards Z, Yupari R, Bena J, Wilkinson A, Suh J . Outcomes for posterior uveal melanoma: Validation of American Brachytherapy Society Guidelines. Brachytherapy. 2021; 20(6):1226-1234. DOI: 10.1016/j.brachy.2021.05.165. View

18.

Schulz-Ertner D, Jakel O, Schlegel W . Radiation therapy with charged particles. Semin Radiat Oncol. 2006; 16(4):249-59. DOI: 10.1016/j.semradonc.2006.04.008. View

19.

Lin A, Rao Y, Acharya S, Schwarz J, Rao P, Grigsby P . Patterns of care and outcomes of proton and eye plaque brachytherapy for uveal melanoma: Review of the National Cancer Database. Brachytherapy. 2017; 16(6):1225-1231. DOI: 10.1016/j.brachy.2017.07.014. View

20.

Fili M, Trocme E, Bergman L, See T, Andre H, Bartuma K . Ruthenium-106 versus iodine-125 plaque brachytherapy of 571 choroidal melanomas with a thickness of ≥5.5 mm. Br J Ophthalmol. 2019; 104(1):26-32. DOI: 10.1136/bjophthalmol-2018-313419. View