Uveal melanoma

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Proton beams bring a significant improvement in the physical selectivity of the treatment. The number of proton therapy centers in operation and in the planning stage increases continuously worldwide. The best clinical results, so far, have been reported for uveal melanoma, tumors of the base of skull, and some brain tumors in children. 

Uveal Melanoma. Charged particle beams and, in particular, protons are ideal for treating intraocular lesions since they can be made to deposit their absorbed dose in the target volume, while significantly limiting the irradiation of the noninvolved ocular and orbital structures (Fig. 16). 

Large series of patients with uveal melanoma were treated with protons in several centers worldwide. The Massachusetts General Hospital/Harvard Cyclotron Laboratory (MGH/HCL) in Boston played a pioneering role, and 2568 uveal melanoma patients were treated through September 1998 [38]. 

Figure 16 Proton therapy for uveal melanoma. Dose distribution obtained with a beam of 60-MeV protons with an appropriate spread-out Bragg peak (energy modulated from 14-60 MeV). Transverse section through the center of the eye. The position of the tumor [gross tumor volume (GTV)] is indicated by the posterior hatched area. Protons allow to obtain a homogeneous dose over the whole GTV with effective sparing of the normal structures. This implies a great precision in patient-beam positioning. (Courtesy from PSI, cited in Ref. 3.)...

Chiquet, C., Grange, J.-D., Ayzac, L., Chauvel, P., Patricot, L.-M., and Devouassoux-Shisheboran, M. 2000. Effects of proton beam irradiation on uveal melanomas a comparative study of Ki-67 expression in irradiated versus non-irradiated melanomas. Br. J. Ophthamol. 54 98-102. 

Papadopoulos NE, Plager C, Eton O. Phase II trial of 9-nitrocamptothecin (RFS 2000) for patients with metastatic cutaneous or uveal melanoma. Anticancer Drugs 2002 13(2) 169-72. 

Doxorubicin-resistant tumors Eungal infections Lymphomatous meningitis Metastatic malignant uveal melanoma Ovarian cancer Advanced cancer Various tumors Advanced cancer... 

Uveal melanoma is the most common primary intraocular malignancy seen in adults, but is an uncommon tumor. Unlike cutaneous melanoma, the frequency and mortality of uveal melanoma have remained steady. This melanoma arises from the pigmented epithelium of the choroid. Iris melanoma is a subset of uveal melanoma and tends to have a more benign course. The risk of metastasis varies with the histologic type and size of the tumor, as well as the location in the eye. Metastases occur most frequently in the liver, but have been documented in a variety of tissues. 

DeVries TJ, Trancikova D, Ruiter DJ, et al. High expression of immunotherapy candidate proteins gplOO, MART-1, tyrosinase, and TRP-1 in uveal melanoma. Br J Cancer. 1998 78 1156-1161. 

Mooy CM, Luyten GP, Dejong PT, et al. Neural cell adhesion molecule distribution in primary and metastatic uveal melanomas. Hum Pathol. 1995 26 1185-1190. 

Fuchs U, Kivela T, Summanen P, et al. An immunohistochemical and prognostic analysis of cytokeratin expression in malignant uveal melanoma. Am Pathol. 1992 141 169-181. 

Li FI., Alizadeh FI., and Niederkom J. Y. (2008) Differential expression of chemokine receptors on uveal melanoma cells and their metastases. Invest Ophthalmol Vis Sci., 49, 636-43. 

Di Cesare S., Marshall J. C., Fernandes B. F., et al. (2007) In vitro characterization and inhibition of the CXCR4/CXCL12 chemokine axis inhuman uveal melanoma cell lines. Cancer Cell Int., 7, 17. 

M. Cohen, Transducible peptide therapy for uveal melanoma and retinoblastoma, Arch. Ophthalmol. 2002, 120, 1341-1346. 

Daftari I, Braash D, Lin S and O Brian J (2001) Use of high-frequency ultrasound imaging to improve delineation of anterior uveal melanoma for proton irradiation. Phys Med Biol 46 579-590. 

Kiewe P, Bechrakis NE, Schmittel A, Ruf P, Lindhofer H, Thiel E, Nagor-sen D. Increased chondroitin sulphate proteoglycan expression (B5 immu-noreactivity) in metastases of uveal melanoma. Ann Oncol 2006 17 1830-1834. 

Andrawiss M, Maron A, Beltran W, Opolon P, Connault E, Griscelli F, Yeh P, Perricaudet M, Devauchelle P. Adenovirus-mediated gene transfer in canine eyes A preclinical study for gene therapy of human uveal melanoma. J Gene Med 2001 3 228-239. 

Ocular melanoma can arise from various structures within the eye and accounts for 70% of all primary malignancies of the eye. At the time of diagnosis, metastases are uncommon but appear in 19%-35% of patients within 5 years. Unlike cutaneous melanoma, metastases from uveal melanoma is most commonly found within the liver in more than 50% of patients (Kath et al. 1993), followed by lungs, bone, and... 

Bedikian AY et al. (1995) Treatment of uveal melanoma metastatic to the liver a review of the M D Anderson Cancer Center experience and prognostic factors. Cancer 76 1665-1670... 

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