title: Gamma Knife Radiosurgery for Uveal Metastases: Report of Three Cases and a Review of the Literature.
abstract: OBJECTIVE
  Uveal metastases are ophthalmologic tumors that have historically been treated by fractionated external beam radiation therapy or invasive brachytherapy. The need for rapid response and less invasive management options led the authors to explore the use of Gamma Knife stereotactic radiosurgery (SRS) for this common problem.
  
  
  METHODS
  Interventional case series.
  
  
  METHODS
  To prevent eye movement during the procedure, all 3 patients underwent a retrobulbar anesthetic block followed by magnetic resonance imaging to detect the target. All tumors were treated in a single procedure using the 4C or Perfexion Gamma Knife. The tumors received a minimal tumor dose of 14-20 Gy. Two patients also underwent SRS for additional intracranial metastases.
  
  
  RESULTS
  At follow-up, performed between 4 and 15 months after SRS, all 3 patients demonstrated a reduction in uveal tumor volumes. One patient developed decreased visual acuity secondary to radiation retinopathy.
  
  
  CONCLUSIONS
  In this early experience, SRS was found to be an effective management option for uveal metastases associated with systemic cancer. Patients can be screened and treated effectively early after diagnosis using a joint approach between ophthalmologists and neurosurgeons. Systemic oncologic care can continue without interruption.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: areswj@upmc.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Ares
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tonetti
authors.affiliation: Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Jenny Y
authors.initials: JY
authors.lastname: Yu
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Monaco
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: L Dade
authors.initials: LD
authors.lastname: Lunsford
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D014604:Uveal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000556:secondary; D014792:Visual Acuity