ABSTRACT
PURPOSE: To compare quality of life (QoL) in patients with uveal melanoma after enucleation and stereotactic radiosurgery to that in an age-matched patient collective. METHODS: QoL was assessed in a cross-sectional survey and compared among 32 uveal melanoma patients after enucleation, 48 patients after stereotactic radiosurgery (CyberKnife(®); Accuray(®) Incorporated, Sunnyvale, CA, USA), and an age-matched control group of 35 patients, using the SF-12 Health Survey. Statistical analysis was performed with Fisher's exact test, Student's t test, one-way ANOVA analysis, Wilcoxon rank-sum (Mann-Whitney test), and ordered logistic regression for multivariate analysis. RESULTS: There was no significant difference in QoL between patients treated by stereotactic radiosurgery and the age-matched control group. After enucleation, patients presented significantly lower values in Physical Functioning (PF), Role Physical (RP), and Role Emotional (RE) compared to the radiosurgery and control group. To control for the overall QoL lowering effect of visual loss, the QoL of the patients who underwent enucleation was compared with the QoL of patients suffering severe functional loss after CyberKnife radiosurgery in a subgroup analysis, which showed no statistically significant difference. The number of comorbidities had a significant impact on QoL in multivariate analysis. CONCLUSIONS: Superior performance in PF, RP, and RE suggests that CyberKnife represents a suitable first-line therapy for uveal melanoma. In cases with painful amaurosis or vast tumor recurrence, enucleation can be performed with an acceptable QoL outcome.
Subject(s)
Eye Enucleation , Melanoma/psychology , Melanoma/therapy , Quality of Life/psychology , Radiosurgery , Uveal Neoplasms/psychology , Uveal Neoplasms/therapy , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Melanoma/radiotherapy , Melanoma/surgery , Middle Aged , Retrospective Studies , Sickness Impact Profile , Surveys and Questionnaires , Uveal Neoplasms/radiotherapy , Uveal Neoplasms/surgeryABSTRACT
Purpose of this study is to evaluate radiographic therapy response, clinical outcome and adverse effects of CyberKnife radiosurgery in patients suffering from orbital metastases. Sixteen orbital metastases originating from different solid cancers in fourteen patients were treated by single fraction CyberKnife radiosurgery. Radiographic response and clinical outcome were evaluated. The treated tumor volume ranged from 0.2 to 35 cm3 (median 2.3 cm3, mean 7.0 cm3, SD 6 10.4 cm3, CI 0.9-9.4 cm3). The prescription dose ranged from 16.5-21 Gy (median 18 Gy, mean 18.2 Gy, SD 6 1.2 Gy, CI 17.0-18.4 Gy). A no change situation was observed in nine lesions, partial remission in four as well as complete remission in one metastasis. Tumor growth was stabilized or regressive following CyberKnife therapy in 87% of the cases. Recurrence was observed in two cases (13%). Before therapy, three patients suffered from visual disturbance and five patients reported diplopia. Six patients had no initial symptoms. After therapy, one patient indicated improvement of the present visual deficit and two patients no change. Out of the two patients with persistent diplopia, two reported improvement after therapy and three no change. No progression of symptoms was noted in any of the cases. Fourteen out of sixteen treated lesions were stable or regressive following CyberKnife radiosurgery (87%). As no serious adverse effects were reported in this series, CyberKnife therapy was shown to be of great value for local management of orbital metastases.
Subject(s)
Orbital Neoplasms/surgery , Radiosurgery , Adult , Aged , Female , Humans , Male , Middle Aged , Orbital Neoplasms/diagnostic imaging , Orbital Neoplasms/mortality , Orbital Neoplasms/secondary , Radiation Dosage , Radiography , Retrospective Studies , Treatment OutcomeABSTRACT
In order to obtain a deeper insight into the molecular mechanism controlling the cellular response to high-linear energy transfer (LET) radiation, the number and size of pATM (S1981) and gamma-H2AX foci were compared in cultures of diploid human fibroblasts after exposure to charged particles of varying species, energy and LET at the NIRS-HIMAC-facility (Chiba, Japan). Particle LET ranged from 2.2 to 300 keV/mum, and a low fluence of 7.3 x 10(4) cm(-2) was chosen. Therefore, about 1 out of 7 nuclei was traversed by a particle. Doses and LET were verified with thermoluminescence detectors (LiF:Mg, Ti) evaluated according to the high temperature ratio method. Two hours after irradiation, fibroblasts were fixed and the subcellular distribution of pATM (S1981) and gamma-H2AX was visualised by immunofluorescence or histochemical staining using phosphorylation-specific antibodies. It was found that the number of pATM (S1981) foci per nucleus was higher after exposure to higher-LET particles. Irradiation with the two highest LET beams (Fe-ions, 197 and 300 keV/mum) gave a significant increase in the number of pATM foci, whereas ions with an LET lower than 30 keV/mum yielded similar numbers of pATM foci compared with unirradiated control samples. These data show that the early cellular response to high-LET radiation is modulated by the energy deposition of the particle. Therefore, the correlation between the microdosimetric aspect of energy deposition and biologic consequences at low radiation doses deserves further study.
