Choroidal Melanoma Stage T1 – Comparison of the Planning Protocol for Stereotactic Radiosurgery and Proton Beam Irradiation


Authors: A. Furdová 1;  J. Růžička 2;  M. Šramka 3;  G. Králik 3;  M. Chorvath 3;  P. Kusenda 1
Authors‘ workplace: Klinika oftalmológie Lekárskej fakulty Univerzity Komenského a Univerzitnej nemocnice, Nemocnica Ružinov, Bratislava, prednosta: doc. MUDr. Vladimír Krásnik, PhD. 1;  Katedra jadrovej fyziky a biofyziky, Fakulta matematiky, fyziky a informatiky Univerzity Komenského, Bratislava, vedúci katedry doc. RNDr. Karol Holý, CSc. 2;  Klinika stereotaktickej rádiochirurgie OÚSA a Vysokej školy zdravotníctva a sociálnej práce sv. Alžbety, Bratislava, prednosta prof. MUDr. Miron Šramka, DrSc. 3
Published in: Čes. a slov. Oftal., 68, 2012, No. 4, p. 156-161
Category: Original Article

Overview

Objective:
Comparison of two methods of irradiation of patients with malignant choroidal melanoma – stereotactic radiosurgery and proton beam irradiation. External (non-contact) applied irradiation is used as a source of accelerated protons, respectively helium ions. This method allows applications of ionizing irradiation also despite the low radiosensitivity of cells of malignant melanoma of the uvea (MMU). External source of ionizing radiation is modulated current energy electrons, protons or neutrons, accelerated in linear accelerators. From the external medium voltages resources (4-16 MeV) are irradiated tissues with target dose of 5.0–24.0 Gy. Volume protons permeate straight the structures of the eye to a certain distance. The use of proton radiation density of ionized protons increases in the vicinity of the impact due to energy losses for electrons interacting with the environment. At the end of the track there is a huge increase in the ionization dose (“Bragg spike”). Therefore, the structures surrounding the eye at the point of entry and little affected and increasing the dose at the end of the proton beam is ideal for the desired therapeutic effect. Fractionated application is also possible.

Case report:
In December 2011 we performed stereotactic radiosurgery to treat female patient (born 1939) with malignant melanoma of the choroid stage T1 N0 M0. Plan has been drawn up for stereotactic irradiation – model for linear accelerator Clinac, Corvus planning system ver. 6.2, verification and OmniPro IMRT planning system Liebinger ver. 4.3. Patient characteristics were compared with the virtual plan for proton radiation therapy, and we used the scheme in Physical parameters FIAN-technical center in the Russian Federation. We compared both planning protocols and assess in particular the extent of radiation surrounding non-tumor tissue.

Results:
When comparing the two planning schemes irradiation levels of surrounding tissues and risk structures (lens, optic nerve, chiasm) in both methods were corresponding to the required standard.

Conclusion:
Treatment of uveal melanoma through proton beam irradiation in Slovakia is not available yet, although it has several advantages, such as fractionation and the possibility of achieving a higher dose of irradiation to deposit (more than 50.0 Gy). The fundamental difference between the two methods for an eye is particularly the possibility of proton beam irradiation exposure of tumor of iris and ciliary body, which can not be solved through stereotactic radiosurgery. The dose to the tumor during irradiation can be optimized. The model device allowed us to make OPTMI – Therapy (Proton Treatment with Optimized Modulated Intensity).

Key words:
malignant melanoma of the choroid, stereotactic radiosurgery for uveal melanoma, proton beam irradiation


Sources

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Ophthalmology
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