Francisco López-Lara

High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma

Aims To evaluate episcleral plaque radiotherapy with high-dose 125I for the treatment of circumscribed choroidal haemangioma (CCH). Methods A retrospective review was performed of patients treated for CCH between 1995 and 2007. Brachytherapy was performed with ROPES plaques loaded with 125I seeds with a target apex dose of 48 Gy. Main outcome measures were regression of CCH, resolution of retinal detachment, visual acuity changes and frequency of radiation-related complications. Results Eight patients met the inclusion criteria. Mean tumour base was 11.3 (range 7.8–14.3) mm and mean height was 4.4 (range 2.8–6.5) mm. Six patients had an associated retinal detachment and seven macular exudates or oedema. Mean preoperative visual acuity ranged from no light perception to 0.7. Three patients had received prior argon laser treatment. All patients received one radiation treatment, since no new symptoms due to CCH developed during follow-up (mean 83 (range 23–123) months). Tumour regression was found in all cases. Three patients presented radiation retinopathy and one subretinal fibrosis. Visual acuity remained stable in six patients and decreased two or more lines in two patients. Conclusions Episcleral brachytherapy led to tumour regression and resolution of non-rhegmatogenous secondary retinal detachments in this case series that included large CCH. Visual stabilisation was achieved in most cases. Given the acceptable rate of side effects detected, 125I episcleral brachytherapy should be considered in large tumours, in tumours with a subfoveal location or extensive subretinal fluid, and in tumours that have failed to respond to other treatments.

Prevalence of ocular and oculodermal melanocytosis in Spanish population with uveal melanoma

PurposeThe aim of this study was to determine the prevalence of ocular and oculodermal melanocytosis (ODM) among patients with uveal melanoma (UM) in a Spanish population.MethodsRetrospective review of the medical records of patients with ODM among patients with UM.ResultsTen (11 eyes) of 400 patients (2.7%) with UM associated had ODM. The mean age at diagnosis of UM among patients with ODM was 62 years. One patient had bilateral tumours. UM was diagnosed during a routine-examination in two cases. All tumours were medium (7/11) or large (4/11) in size, with a mean maximum base of 13 mm and height of 7 mm. No patient had extraocular extension or metastatic disease at diagnosis. Enucleation was done in five cases and I-125-brachytherapy in six. The mean follow-up was 43 months. One patient died because of metastasis 2 years after enucleation; one patient is currently on treatment of systemic metastasis 11 years after.ConclusionsODM is more frequent in spanish population with UM than in American population. Despite the risk of UM in ODM, it is often diagnosed late when a conservative treatment is not indicated.

Episcleral brachytherapy for uveal melanoma:: analysis of 136 cases

PurposeTo assess the results of I-125 episcleral brachytherapy (EB) in uveal melanoma: tumour control, visual acuity (VA), eye preservation and survival.PatientsProspective and consecutive study of patients with a diagnosis of uveal melanoma at the Ocular Oncology Unit in the Valladolid University Teaching Hospital treated with EB between September 1997 and June 2008. Ocular examination and extraocular and systemic extension data were registered in a database at the time of the diagnosis and during the follow-up.ResultsAmong a total of 310 patients diagnosed between September 1997 and June 2008, 136 were treated with EB (mean age, 58.3). Mean follow-up was 55.3 months. As for tumour type, 66.9% were nodular and 39% mushroom shaped. With respect to size, 80.9% were medium, 7.4% small and 11.8% large. After 4.6 years of follow-up, tumours were controlled in 97.1%, with a 55.1% reduction in mean height; only 2.9% of patients showed recurrence. VA was maintained in 16.2% of patients and 17.6% showed an increase; 33% had retinopathy and 14.6% optic neuropathy. Only 5.1% of patients underwent enucleation due to complications and there has been 1 melanoma-related death to date.ConclusionsI-125 EB is effective in tumour control, allowing preservation of the eye and useful visual function for the majority of patients.

Visual outcome after posterior uveal melanoma episcleral brachytherapy including radiobiological doses

Purpose To assess the long-term influence of radiobiological doses in the evolution of visual acuity (VA) in patients with uveal melanoma treated by episcleral brachytherapy. Material and methods Visual acuity was evaluated prospectively from a case series of 243 patients in 2016 treated with 125I. Data analysis was applied to trend VA outcome and find the accurate best-fit line. Biologically effective dose (BED) was included in survival analysis with the use of Kaplan-Meier and Cox regressions. Hazard ratio (HR) and confidence interval at 95% (CI) were determined. Variables statistically significant were analyzed and compared by log-rank tests. Results The median follow-up was 74.2 months (range, 3-223). Exponential regression shows a 25% reduction and 50% in visual acuity score (VAS) scale for 5 and 27.8 months, respectively. Cumulative probabilities of survival analysis were 57%, 42%, 27%, and 23% at 3, 5, 10, and 15 years, respectively. Multivariable analysis found tumor height (HR = 1.18, 95% CI: 1.07-1.29), applicator size (HR = 1.22, 95% CI: 1.08-1.36), juxtapapillary localization (HR = 1.70, 95% CI: 1.01-2.84), and dose to foveola (HR = 1.01, 95% CI: 1.00-1.01) significantly associated with VA loss. Log-rank tests were significant for all those variables. BED has a strong influence in univariate model, but not statistically significant in the multivariate one. Conclusions Visual acuity changes can be modeled by an exponential function for the first 5 years after treatment. No relation between VA loss and BED has been found; nevertheless, apical height, plaque size, juxtapapillary localization, and dose to fovea were found as statistical significant variables.

Radiobiological doses, tumor, and treatment features influence on local control, enucleation rates, and survival after epiescleral brachytherapy. A 20-year retrospective analysis from a single-institution: part I

Purpose To assess influence of the radiobiological doses, tumor, and treatment features on local control, enucleation rates, overall and disease-specific survival rates after brachytherapy for posterior uveal melanoma. Material and methods Local control, enucleation, overall and disease-specific survival rates were evaluated on the base of 243 patients from 1996 through 2016, using plaques loaded with iodine sources. Clinical and radiotherapy data were extracted from a dedicated prospective database. Biologically effective dose (BED) was included in survival analysis using Kaplan-Meier and Cox regressions. The 3-, 5-, 10-, and 15-year relative survival rates were estimated, and univariate/multivariate regression models were constructed for predictive factors of each item. Hazard ratio (HR) and confidence interval at 95% (CI) were determined. Results The median follow-up was 73.9 months (range, 3-202 months). Cumulative probabilities of survival by Kaplan-Meier analysis at 3, 5, 10 and 15 years were respectively: 96%, 94%, 93%, and 87%, for local control; 93%, 88%, 81%, and 73% for globe preservation; 98%, 93%, 84%, and 73% for overall survival, and 98%, 96%, 92%, and 87% for disease-specific survival. By multivariate analysis, we concluded variables as significant: for local control failure – the longest basal diameter and the juxtapapillary location; for globe preservation failure – the longest basal dimension, the mushroom shape, the location in ciliary body, and the dose to the foveola; for disease-specific survival – the longest basal dimension. Some radiobiological doses were significant in univariate models but not in multivariate ones for the items studied. Conclusions The results show as predictive factors of local control, enucleation, and disease-specific survival rates those related with the features of the tumor, specifically the longest basal dimension. There is no clear relation between radiobiological doses or treatment parameters in patients after brachytherapy.

Infiltrative Intraocular Conjunctival Squamous Cell Carcinoma after Local Resection and Brachytherapy: Clinical and Pathological Findings

A pseudophakic 70-year-old man presented to the clinic with a slow-growing conjunctival mass in the left eye. He was diagnosed with a conjunctival exophytic lesion suspicious of invasive conjunctival squamous cell carcinoma (CSCC). Excisional biopsy showed a well-differentiated CSCC with positive margins and the patient underwent adjuvant brachytherapy. Six weeks later, examination of the anterior segment revealed cells in the anterior chamber and a neurotrophic corneal ulcer with corneal perforation. Considering the high suspicion of intraocular invasion of CSCC, the left eye was enucleated. Histopathologic findings showed scarring of the ciliary body with fibrosis temporally. Nasally, the sclera showed a lobular infiltration of well-differentiated squamous carcinoma. The central cornea exhibited a large ulcer with perforation and infiltrating squamous cells adhering to the posterior surface. To our knowledge, this is the first documented case of an intraocular diffuse recurrence of CSCC after resection and adjuvant brachytherapy, with clinicopathologic correlation of radiation effects on the ocular tissues.

An approach to vmat on radiation therapy treatments of pelvic and paraaortic lymph nodes

Abstract Introduction When large volumes need to be irradiated multiple organs at risk are involved. There is no doubt about the preeminence for conformal index and sparing of critical structures for VMAT, but an alternative regarding the use of single or multiple isocenter shows a subject for detailed analysis. Purpose To compare VMAT in treatment of pelvic and paraaortic lymph nodes using single or double isocenter. Materials and Methods A set of five patients are selected. For every patient an expert radiation oncologist contoured on CT images volumes and organs according to the RTOG guidelines. Plans were done in Eclipse 11 using Accuros XB algorithm for 6MV X-rays from a Clinac 2100-120MLC, using VMAT double full rotation arc with collimator rotation 30°-330°. For isocenter placement the Arc Geometric tool are used, for double isocenter only we allowed only longitudinal couch movement between isocenters. The same plan objectives are used for every single isocentre plan, but for organs at risk adjustments are made during optimization in order to get the best result for each case. When using double isocentre the VMAT paraoortic plan is used as dose base for VMAT pelvic optimization. Results Single isocenter shows higher irradiated volumes V5 are 1–2% and V20 up to 14%, sparing for liver and kidneys are improve for the double isocenter but with an average increase of 10% in monitor units each plan. Conclusion Double isocenter plan improves organ sparing but worse PTV dose homogeneity. Disclosure No conflicts of interest to declare.

Bilateral choroidal melanoma a patient with bilateral melanocytosis

Purpose Ocular melanocytosis, is a congenital condition characterized by hyperpigmentation of the episclera and uvea.. There is a clear association between this condition and uveal melanoma in Caucasian populations. We report a case of a patient affect of bilateral ocular malanocytosis whom has recently been diagnosticated of bilateral choroidal melanoma.

Episcleral brachytherapy as simultaneous treatment of choroidal melanoma and neovascular membrane

Episcleral brachytherapy as simultaneous treatment of choroidal melanoma and neovascular membrane Marı́a A. Saornil*, Janneth S. Hincapié, Francisco López-Lara, Maria I. López, Gonzalo Blanco, Jesus M. De Frutos Ophthalmology Department, Ocular Oncology Unit, Hospital Clinico Universitario Valladolid, Spain Fundación Carolina postgraduate master, Instituto Universitario de Oftalmobiologı́a Aplicada, Valladolid, Spain Oncology and Radiotherapy Department, Hospital Clinico Universitario, Valladolid, Spain