Gamma Knife Perfexion Radiosurgery for Intraocular Tumor-Technique Establishment and Preliminary Results

Yi Chieh Tsai; Jia-Wei Lin; Shih-Chung Lai; An-Cheng Shiau; Chih-Chieh Chang; Jo-Ting Tsai

doi:10.6316/TRO/201320(3)179

Gamma Knife Perfexion Radiosurgery for Intraocular Tumor-Technique Establishment and Preliminary Results

貢獻的翻譯標題: 加馬刀(Perfexion)於眼球內腫瘤之應用－技術建立與初步結果

Yi Chieh Tsai, Jia-Wei Lin, Shih-Chung Lai, An-Cheng Shiau, Chih-Chieh Chang, Jo-Ting Tsai

研究成果: 雜誌貢獻 › 文章 › 同行評審

摘要

目的：放射線手術用於治療眼球內腫瘤對於保留視力與眼球保存佔有重要的角色，與近接治療相比，用於葡萄膜黑色素瘤病人，放射線手術亦提供了一個非侵入性與單次之治療方式。此外放射線手術之適應症可用於其他眼球內疾病。此篇研究主要為評估新設計之加馬刀治療方法及流程，用於眼球內腫瘤之定位準確性與臨床結果。材料與方法：選擇2位葡萄膜黑色素瘤病人與1位乳癌併眼球內轉移之病人接受加馬刀（Perfexion）治療。病人先接受球後麻醉，並將兩條眼球外肌肉縫合固定於頭部立體定位框架上，做為眼球之固定，之後安排磁振造影掃描以製作加馬刀計畫。單次治療處方劑量為25-30 Gy，治療計畫選擇50-55%的等劑量曲線範圍包覆靶體積。病人分別於固定頭架之後（CT-1），治療之前（CT-2），及治療之後（CT-3）共會掃描三組電腦斷層，藉此比較腫瘤之體積，腫瘤與水晶體之重心位置與位移，來分析定位之準確性。結果：眼球移動分析結果，在三組電腦斷層影像CT-1 、CT-2 、CT-3 上，腫瘤與水晶體之重心位置位移均小於0.120公厘，在給予劑量的腫瘤包覆率均高於95%。在三位病人的追蹤中可見腫瘤體積之縮小與視網膜剝離之改善。結論：根據本研究加馬刀手術之治療方法與流程，加馬刀運用於眼球內腫瘤治療具有高準確性。加馬刀可提供眼球內腫瘤非侵入性及單次治療之器官保留治療方式。

貢獻的翻譯標題	加馬刀(Perfexion)於眼球內腫瘤之應用－技術建立與初步結果
原文	英語
頁（從 - 到）	179-190
頁數	12
期刊	放射治療與腫瘤學
卷	20
發行號	3
DOIs	https://doi.org/10.6316/TRO/201320(3)179
出版狀態	已發佈 - 2013

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10.6316/TRO/201320(3)179

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@article{17bbf6dcf6b4427ab8bdde18c9ee030a,

title = "Gamma Knife Perfexion Radiosurgery for Intraocular Tumor-Technique Establishment and Preliminary Results",

abstract = "Purpose: Radiosurgery plays an important role in treating patients with intraocular tumor and retained visual function aiming at organ-conservation. Gamma knife stereotactic radiosurgery (GKRS) provides a relatively non-invasive and less time-consuming procedure for treating patients with choroidal melanoma comparing with plaque brachytherapy. It also has the potential radiosurgery to provide effective treatment for other ophthalmologic indication. We presented a new treatment protocol using GKRS to treat patient with intraocular tumor and evaluated the safety and precision of GKRS as a primary treatment for intraocular tumor.Methods: Two patients with uveal melanoma and one patient with breast cancer orbital metastasis treated with the Leksell Gamma Knife Perfexion stereotactic radiosurgery in our hospital. Retrobulbar anesthesia following fixation of the treated eye by suturing two extraocular muscles to the stereotactic frame were performed in order to immobilize the eye in the whole treatment procedure. The dose to the tumor margin was 25-30 Gy prescribed at 50-55% isodose line. Contrast-enhanced MRI was used for Gamma Plan dose planning. CT scans were done after eye fixation, immediate before and after the GKRS to confirm the accuracy of tumor localization. We compared tumor volume, tumor and lens gravity point deviation, and tumor coverage in the 3 sets of CT scans to check the precision of immobilization and eye fixation.Results: The eye movement analysis revealed that the gravity point coordination deviation of the tumor and lens between CT-1 and CT-2, or CT-1 and CT-3 was less than 0.120 mm. At least 95% of the tumor volume was covered by the prescription dose in the 3 sets of CT image. After GKRS, tumor shrinkage and serous retinal detachments disappearance were noted by ophthalmoscopy and orbital MRI in two patients. No major complication was found during follow up.Conclusion: GKRS using our treatment protocol is a relatively non-invasive, organconserving, and less time-consuming single fraction treatment for intraocular tumor. Our eye fixation method reveals high accuracy. Larger study with long term follow up is needed to evaluate the dose response result of the patients.",

keywords = "加馬刀Perfexion, 立體定位放射線手術, 葡萄膜黑色素瘤, Leksell Gamma Knife Perfexion, Stereotactic radiosurgery, Uveal melanoma",

author = "Tsai, {Yi Chieh} and Jia-Wei Lin and Shih-Chung Lai and An-Cheng Shiau and Chih-Chieh Chang and Jo-Ting Tsai",

year = "2013",

doi = "10.6316/TRO/201320(3)179",

language = "English",

volume = "20",

pages = "179--190",

journal = "放射治療與腫瘤學",

issn = "1023-988x",

publisher = "台灣放射腫瘤學會",

number = "3",

}

TY - JOUR

T1 - Gamma Knife Perfexion Radiosurgery for Intraocular Tumor-Technique Establishment and Preliminary Results

AU - Tsai, Yi Chieh

AU - Lin, Jia-Wei

AU - Lai, Shih-Chung

AU - Shiau, An-Cheng

AU - Chang, Chih-Chieh

AU - Tsai, Jo-Ting

PY - 2013

Y1 - 2013

N2 - Purpose: Radiosurgery plays an important role in treating patients with intraocular tumor and retained visual function aiming at organ-conservation. Gamma knife stereotactic radiosurgery (GKRS) provides a relatively non-invasive and less time-consuming procedure for treating patients with choroidal melanoma comparing with plaque brachytherapy. It also has the potential radiosurgery to provide effective treatment for other ophthalmologic indication. We presented a new treatment protocol using GKRS to treat patient with intraocular tumor and evaluated the safety and precision of GKRS as a primary treatment for intraocular tumor.Methods: Two patients with uveal melanoma and one patient with breast cancer orbital metastasis treated with the Leksell Gamma Knife Perfexion stereotactic radiosurgery in our hospital. Retrobulbar anesthesia following fixation of the treated eye by suturing two extraocular muscles to the stereotactic frame were performed in order to immobilize the eye in the whole treatment procedure. The dose to the tumor margin was 25-30 Gy prescribed at 50-55% isodose line. Contrast-enhanced MRI was used for Gamma Plan dose planning. CT scans were done after eye fixation, immediate before and after the GKRS to confirm the accuracy of tumor localization. We compared tumor volume, tumor and lens gravity point deviation, and tumor coverage in the 3 sets of CT scans to check the precision of immobilization and eye fixation.Results: The eye movement analysis revealed that the gravity point coordination deviation of the tumor and lens between CT-1 and CT-2, or CT-1 and CT-3 was less than 0.120 mm. At least 95% of the tumor volume was covered by the prescription dose in the 3 sets of CT image. After GKRS, tumor shrinkage and serous retinal detachments disappearance were noted by ophthalmoscopy and orbital MRI in two patients. No major complication was found during follow up.Conclusion: GKRS using our treatment protocol is a relatively non-invasive, organconserving, and less time-consuming single fraction treatment for intraocular tumor. Our eye fixation method reveals high accuracy. Larger study with long term follow up is needed to evaluate the dose response result of the patients.

AB - Purpose: Radiosurgery plays an important role in treating patients with intraocular tumor and retained visual function aiming at organ-conservation. Gamma knife stereotactic radiosurgery (GKRS) provides a relatively non-invasive and less time-consuming procedure for treating patients with choroidal melanoma comparing with plaque brachytherapy. It also has the potential radiosurgery to provide effective treatment for other ophthalmologic indication. We presented a new treatment protocol using GKRS to treat patient with intraocular tumor and evaluated the safety and precision of GKRS as a primary treatment for intraocular tumor.Methods: Two patients with uveal melanoma and one patient with breast cancer orbital metastasis treated with the Leksell Gamma Knife Perfexion stereotactic radiosurgery in our hospital. Retrobulbar anesthesia following fixation of the treated eye by suturing two extraocular muscles to the stereotactic frame were performed in order to immobilize the eye in the whole treatment procedure. The dose to the tumor margin was 25-30 Gy prescribed at 50-55% isodose line. Contrast-enhanced MRI was used for Gamma Plan dose planning. CT scans were done after eye fixation, immediate before and after the GKRS to confirm the accuracy of tumor localization. We compared tumor volume, tumor and lens gravity point deviation, and tumor coverage in the 3 sets of CT scans to check the precision of immobilization and eye fixation.Results: The eye movement analysis revealed that the gravity point coordination deviation of the tumor and lens between CT-1 and CT-2, or CT-1 and CT-3 was less than 0.120 mm. At least 95% of the tumor volume was covered by the prescription dose in the 3 sets of CT image. After GKRS, tumor shrinkage and serous retinal detachments disappearance were noted by ophthalmoscopy and orbital MRI in two patients. No major complication was found during follow up.Conclusion: GKRS using our treatment protocol is a relatively non-invasive, organconserving, and less time-consuming single fraction treatment for intraocular tumor. Our eye fixation method reveals high accuracy. Larger study with long term follow up is needed to evaluate the dose response result of the patients.

KW - 加馬刀Perfexion

KW - 立體定位放射線手術

KW - 葡萄膜黑色素瘤

KW - Leksell Gamma Knife Perfexion

KW - Stereotactic radiosurgery

KW - Uveal melanoma

U2 - 10.6316/TRO/201320(3)179

DO - 10.6316/TRO/201320(3)179

M3 - Article

SN - 1023-988x

VL - 20

SP - 179

EP - 190

JO - 放射治療與腫瘤學

JF - 放射治療與腫瘤學

IS - 3

ER -

Gamma Knife Perfexion Radiosurgery for Intraocular Tumor-Technique Establishment and Preliminary Results

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