Use of high-frequency ultrasound imaging to improve delineation of anterior uveal melanoma for proton irradiation.
The aim of this study was to evaluate high-frequency ultrasound imaging (HFUI) as an aid in localizing anterior margins of tumours of the eye for proton therapy. Proton irradiation of ocular melanoma requires an accurate assessment of all tumour margins. The tumour is marked surgically by suturing to the sclera four or five tantalum rings on the borders of the tumour defined by transillumination. In order to evaluate the clinical usefulness of high-frequency ultrasound imaging, four and five rings were surgically placed in a patient with an iris/ciliary body melanoma and in a patient with ciliochoroidal melanoma using transillumination to localize the tumour margins. Subsequently margins were verified by HFUI. In the first patient, the distances between the rings and the limbus were measured using calipers during surgery and were compared with HFUI measurements and measurements from planning software. The distances were comparable within 0.5 mm. In the second patient the treatment was planned in two different ways using EYEPLAN software. In the first scenario the shape of the tumour and its relation to the rings were obtained from the surgeon's mapping, the fundus drawing using a transilluminating point light source, and the HFUI. In the second scenario, the shape of the tumour was deduced from the ring positions only. It was observed that the maximum difference between the tumour edge as seen on high-frequency ultrasound images and the rings was 2.6 mm. The tumour volume was underestimated by 39% when tumour shape was obtained from ring positions only. During the past year we have utilized HFUI in 18 patients having tumours involving the anterior segment of the eye, among which four were treated with proton therapy. In conclusion, we believe that high-frequency ultrasound imaging provides additional information with respect to the location of tumour margins in ciliary body and anterior uveal melanoma. Occult extension of the tumour within the ciliary body or posterior iris may not be appreciated by transillumination alone.
Department of Radiation Oncology, University of California--San Francisco, 94143, USA. daftari@radonc17.ucsf.edu
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Daftari
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Barash
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Lin
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O'Brien
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055592:Biophysical Phenomena; D001703:Biophysics; D002830:Choroid Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D002924:Ciliary Body; D005260:Female; D006801:Humans; D015811:Iris Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D061766:Proton Therapy; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D013537:Sutures; D013635:Tantalum; D014463:Ultrasonography; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery
D013635:Tantalum