RESUMEN
PURPOSE: To compare visual outcomes and local tumor control between two groups of patients with amelanotic choroidal melanoma treated with brachytherapy alone, or neoadjuvant photodynamic therapy before brachytherapy. METHODS: Patients diagnosed with amelanotic choroidal melanoma were recruited for the study and divided into two groups: brachytherapy alone (Group A) and photodynamic therapy preceding brachytherapy (Group B). Patients of both groups were selected to be comparable. RESULTS: Twenty-six patients with amelanotic choroidal melanoma were enrolled in the study. Within Group B, 1 month after photodynamic therapy, ultrasonography showed reduction of tumor height in 11 patients (73.4%). The mean doses of irradiation to macula and optic nerve, at baseline were 74.37 and 52.07 Gy, whereas after photodynamic therapy there was a decrease of 17.26% (P = 0.008) and 21.22% (P = 0.025), respectively. In terms of visual acuity, a mean decrease of 14 ETDRS letters and 5 ETDRS letters was observed at 24 months follow-up, in Groups A and B, respectively (P = 0.001). CONCLUSION: Photodynamic therapy as neoadjuvant therapy before brachytherapy reduces tumor thickness in 73.4% of cases. As a result, a decrease of radiation toxic effects on visual function could be obtained, without compromising disease control.
Asunto(s)
Braquiterapia , Neoplasias de la Coroides/terapia , Melanoma Amelanótico/terapia , Fotoquimioterapia , Agudeza Visual/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Coroides/tratamiento farmacológico , Neoplasias de la Coroides/fisiopatología , Neoplasias de la Coroides/radioterapia , Terapia Combinada , Femenino , Angiografía con Fluoresceína , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Melanoma Amelanótico/tratamiento farmacológico , Melanoma Amelanótico/fisiopatología , Melanoma Amelanótico/radioterapia , Persona de Mediana Edad , Terapia Neoadyuvante , Fármacos Fotosensibilizantes/uso terapéutico , Porfirinas/uso terapéutico , Estudios Prospectivos , Dosificación Radioterapéutica , Radioisótopos de Rutenio/uso terapéutico , VerteporfinaRESUMEN
BACKGROUND: The aim of this work is to report on conservation of visual acuity after eccentric ruthenium(106) (Ru-106) brachytherapy of posterior choroidal melanoma. METHODS: Fifty-four patients with choroidal melanoma extending to within 5 mm of the optic disc or fovea were treated at a single institution during the 3 years up to July 31, 2007. The plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin to reduce the radiation dose to the optic disc and fovea. The main outcome measures were local tumor control and conservation of vision of 6/12 or better, according to baseline variables. RESULTS: The tumors had a mean longest basal diameter of 12.0 mm and a mean thickness of 3.1 mm. The posterior tumor margin extended to within 3 mm of the fovea in 30 patients (56%). In the 24 eyes with the posterior tumor margin located 3.1-5.0 mm from the fovea, 74.9% retained visual acuity of 6/12 or better 4 years after treatment (95% confidence interval [CI], 55.5-94.3%). In the 30 eyes with tumor extension to within 3.0 mm of the fovea, then 3 years after treatment only 25.3% retained such vision (95% CI, 5.3-45.3%). Recurrence at the posterior tumor margin occurred in two patients. CONCLUSIONS: Eccentric ruthenium(106) plaque radiotherapy of posterior choroidal melanoma achieves good rates of local tumor control and conservation of vision if special measures are taken to ensure that the plaque is positioned correctly.
Asunto(s)
Braquiterapia , Neoplasias de la Coroides/radioterapia , Melanoma/radioterapia , Radioisótopos de Rutenio/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias de la Coroides/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Melanoma/fisiopatología , Persona de Mediana Edad , Dosificación Radioterapéutica , Factores de Tiempo , Resultado del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To report the long-term therapeutic results for patients with conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma who were treated with intralesional injections of interferon-α (IFN-α). DESIGN: Prospective, nonrandomized, interventional case series. PARTICIPANTS: Twenty eyes of 16 patients with histologically proven conjunctival MALT lymphoma in the absence of systemic disease. METHODS: Patients were given 1,500,000 international units (IU) of IFN-α (Roferon-A; Roche s.p.a., Milano, Italy) subconjunctivally inside the lesion 3 times weekly for 4 weeks. If there was even a minimal response, a further cycle of 1,000,000 IU 3 times weekly for 4 weeks was administered. MAIN OUTCOME MEASURES: Patients were followed up clinically using slit-lamp examination to determine evidence of tumor disappearance or recurrence. In 10 eyes, an incisional biopsy was performed 6 months after therapy to verify the histologic absence of the lesion. RESULTS: A complete response was obtained in 15 eyes (75%) at the end of first cycle treatment, and in 5 eyes (25%) after further cycles. Seventeen eyes (85%) showed no local recurrence after a median follow-up of 65 months (range, 15-136 months). Three eyes (15%) demonstrated recurrence at variable points after treatment. One patient with stage IIA lymphoma exhibited systemic lymphoma progression. CONCLUSIONS: Local immunotherapy with IFN-α seems to be an effective and lasting treatment method and provides an alternative to radiotherapy for conjunctival MALT lymphomas. Very few transient side effects were detected.
Asunto(s)
Neoplasias de la Conjuntiva/tratamiento farmacológico , Factores Inmunológicos/administración & dosificación , Interferón-alfa/administración & dosificación , Linfoma de Células B de la Zona Marginal/tratamiento farmacológico , Adulto , Anciano , Neoplasias de la Conjuntiva/patología , Femenino , Estudios de Seguimiento , Humanos , Factores Inmunológicos/efectos adversos , Inmunoterapia , Inyecciones Intralesiones , Interferón alfa-2 , Interferón-alfa/efectos adversos , Linfoma de Células B de la Zona Marginal/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/efectos adversos , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To report a case of a lymphoepithelioma-like carcinoma (LELC), which is a variant of carcinoma most commonly involving the nasopharynx and rarely occurring in a variety of sites outside its typical location. METHODS: We present the case of a 79-year-old Caucasian man with LELC of the lacrimal gland undergoing surgical resection of the mass. RESULTS: The patient had remained disease-free for 2 years, and then he developed homolateral metastases in latero-cervical and parotid lymph nodes, detected by computed tomography and confirmed by fine-needle aspiration biopsy. He did not receive any surgical treatment, radiotherapy, or chemotherapy because of the advanced stage of the disease and poor health condition. CONCLUSIONS: This case report suggests that a diagnosis of lacrimal gland LELC makes combined early and radical therapy necessary.