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      Monte Carlo Simulation of the Treatment of Uveal Melanoma Using Measured Heterogeneous 106Ru Plaques

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background/Aims: Ruthenium plaques are used for the treatment of ocular tumors. The aim of this work is the comparison between simulated absorbed dose distributions tallied in an anthropomorphic phantom, obtained from ideal homogeneous plaques, and real eye plaques in which the actual heterogeneous distribution of <sup>106</sup>Ru was measured. The placement of the plaques with respect to the tumor location was taken into consideration to optimize the effectiveness of the treatment. Methods: The generic CCA and CCB, and the specific CCA1364 and CCB1256 <sup>106</sup>Ru eye plaques were modeled with the Monte Carlo code PENELOPE. To compare the suitability of each treatment for an anterior, equatorial and posterior tumor location, cumulative dose-volume histograms for the tumors and structures at risk were calculated. Results: Eccentric placements of the plaques, taking into account the inhomogeneities of the emitter map, can substantially reduce the dose delivered to structures at risk while maintaining the prescribed dose at the tumor apex. Conclusions: The emitter map distribution of the plaque and the computerized tomography of the patient used in a Monte Carlo simulation allow an accurate determination of the plaque position with respect to the tumor with the potential to reduce the dose to sensitive structures.

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          Most cited references17

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          The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma.

          (2014)
          To present the American Brachytherapy Society (ABS) guidelines for plaque brachytherapy of choroidal melanoma and retinoblastoma.
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            Eye shape in emmetropia and myopia.

            To determine axial, vertical, and horizontal eye dimensions in myopic and emmetropic eyes by using magnetic resonance imaging (MRI) and to relate these to different ocular expansion models of myopia development. The internal length (cornea to retina), height and width (both retina to retina) were measured in emmetropic and myopic eyes (up to -12 D) of 88 participants aged 18 to 36 years. Participants were positioned supine in a clinical MRI scanner. The fixation target was imaged straight ahead of the subject by an overhead 45 degrees inclined mirror. Eye images were acquired with a 7.5-cm receive-only radio frequency surface coil. Axial (horizontal through middle of eye) and sagittal (vertical through visual axis) sections were taken with a T(1)-weighted fast spin-echo sequence. With an increase in myopic refractive correction, myopic eyes became much larger in all three dimensions, but more so in length (0.35 mm/D, 95% confidence interval [CI] 0.28-0.40) than in height (0.19 mm/D, 95% CI 0.09-0.29) and more so in height than in width (0.10 mm/D, 95% CI 0.01-0.20). Based on height and length dimensions, 25% and 29% of myopic eyes exclusively fitted global expansion and axial elongation models, respectively. Based on width and length dimensions, 17% and 39% of myopic eyes exclusively fitted the global expansion and axial elongation models, respectively. Although there are considerable individual variations, in general myopic eyes are elongated relative to emmetropic eyes, more in length than in height and even less in width. Approximately a quarter of the myopic participants fitted each of the global expansion or axial elongation model exclusively. The small proportions are due primarily to the large variability in the dimensions of emmetropic eyes.
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              Ruthenium brachytherapy for uveal melanoma, 1979-2003: survival and functional outcomes in the Swedish population.

              To evaluate observed and relative survival rates, enucleation rates, and visual outcome after ruthenium 106 brachytherapy for uveal melanoma. Retrospective cases series from the Swedish national referral center. Five hundred seventy-nine patients (579 eyes) with choroidal or ciliary body melanomas, including 55 tumors more than 7 mm in height, treated with ruthenium episcleral plaques from January, 1979, through April, 2003. Clinical and radiotherapy data were extracted from a dedicated database, and survival status was determined through population registries. Tumor size was classified according to the Collaborative Ocular Melanoma Study criteria. The 5- and 10-year relative survival rates were estimated, and univariate and multivariate regression models were constructed for predictive factors on observed survival, enucleation, and visual deterioration. Observed and relative survival rate, proportion of secondary enucleation, deterioration of visual acuity to less than 0.5, respectively, to 0.1 or worse. Tumors were classified as small in 10.5%, medium in 78.4%, and large in 9.2% of patients. The 5- and 10-year observed overall survival rates were 83.3% and 71.5%, respectively, and the corresponding relative rates were 95.5% and 94%, respectively. Factors predicting survival were tumor diameter, patient age, and secondary enucleation. One hundred six patients (18%) underwent enucleation up to 14 years after plaque treatment. The only predictive factor for enucleation was tumor size. At 5 years, 31% of the patients retained 0.5 visual acuity or better, and 49% retained better than 0.1 visual acuity. Predictive factors for visual deterioration were visual acuity and distance from posterior tumor border to the foveola. After ruthenium brachytherapy for uveal melanoma, the survival rates and visual outcomes in this population-based investigation were similar to previously published results. The eye was retained in 81.7% of patients. Careful patient selection (presently we only treat melanomas 7 mm or smaller in height) and life-long monitoring for recurrences is warranted.
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                Author and article information

                Journal
                OOP
                OOP
                10.1159/issn.2296-4657
                Ocular Oncology and Pathology
                S. Karger AG
                2296-4681
                2296-4657
                2019
                June 2019
                15 October 2018
                : 5
                : 4
                : 276-283
                Affiliations
                [_a] aWest German Proton Therapy Centre Essen (WPE), Essen, Germany
                [_b] bNCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
                [_c] cFakultät Physik, Technische Universität Dortmund, Dortmund, Germany
                [_d] dKlinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Jena, Jena, Germany
                Author notes
                *Priv.-Doz. Dr. Lorenzo Brualla, West German Proton Therapy Centre Essen (WPE), Hufelandstrasse 55, DE–45122 Essen (Germany), E-Mail lorenzo.brualla@uni-due.de
                Author information
                https://orcid.org/0000-0003-3385-9623
                Article
                492599 PMC6615327 Ocul Oncol Pathol 2019;5:276–283
                10.1159/000492599
                PMC6615327
                31367591
                f631166d-2d92-4396-b46a-f4dfd1e5f32d
                © 2018 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 11 April 2018
                : 31 July 2018
                Page count
                Figures: 7, Pages: 8
                Categories
                Research Article

                Vision sciences,Ophthalmology & Optometry,Pathology
                Eye plaques,Monte Carlo simulation,Treatment planning,Uveal melanoma,Brachytherapy,Ruthenium,PENELOPE,Beta emitter

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