AI Article Synopsis
- Radiation treatment has become the preferred option for uveal melanoma, moving away from the more invasive enucleation approach; a new frameless LINAC solution for fractionated stereotactic radiosurgery (fSRS) was developed to preserve the eye.
- A unique ocular localization box was created featuring adjustable LED lights for patient focus, eye position monitoring with a CCD camera, and tools to track eye movement, ensuring targeted and effective treatment sessions.
- Initial trials with 10 patients showed that the localization box was effective and well-tolerated, yielding high accuracy for positioning with minimal setup errors, paving the way for future trials to further assess its effectiveness and consistency in various settings.*
Article Abstract
Introduction: Radiation treatment has replaced enucleation as an organ-preservation treatment for patients with uveal melanoma (UM). We developed a novel non-invasive, frameless LINAC based solution for fractionated stereotactic radiosurgery (fSRS) treatment.
Methods: We designed and constructed the a stereotactic ocular localization box that can be attached and indexed to a stereotactic LINAC tabletop. It contains adjustable LED lights as a gaze focus point and CCD camera for monitoring of the patient's eye position. The device also has 6 infrared spheres compatible with the ExacTRAC IGRT system. Treatment plans were developed using iPLAN Dose version 4.5, with conformal dynamic arcs and 6MV photon beam in flattening filter free mode, dosed to 50Gy in 5 fractions. During treatment, patients were instructed to stare at the light when a radiation beam is prepared and ready for delivery. Eye movement was tracked throughout treatment. Residual setup errors were recorded for evaluation.
Results: The stereotactic ocular localization box was 3D-printed with polylactic acid material and attached to the stereotactic LINAC tabletop. 10 patients were treated to evaluate the feasibility, tolerability and setup accuracy. Median treatment time for each arc is 17.3 ± 2.4 seconds (range: 13.8-23.4). After ExacTRAC setup, the residual setup errors are -0.1 ± 0.3 mm laterally, -0.1 ± 0.3 mm longitudinally, and 0 ± 0.2 mm vertically. The residue rotational errors are -0.1 ± 0.3 degree pitch, 0.1 ± 0.2 degree roll, and 0 ± 0.2 degree couch rotation. All patients received treatment successfully.
Conclusion: We successfully developed a novel non-invasive frameless mask-based LINAC solution for SRS for uveal melanoma, or other ocular tumors. It is well tolerated with high set up accuracy. Future directions for this localization box would include a multi-center trial to assess the efficacy and reproducibility in the fabrication and execution of such a solution for UM therapy.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10999567 | PMC |
| http://dx.doi.org/10.3389/fonc.2024.1365197 | DOI Listing |
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