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Initial experience with gamma ray technology shows efficacy as alternative to enucleation
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WAILEA, Hawaii — In his initial experience with Gamma Knife surgery, a surgeon showed efficacy in treating ocular tumors that would have otherwise required enucleation.
 Jay S. Duker |
"This is something you might want to consider in patients who otherwise would be enucleated," Jay S. Duker, MD, said at Retina 2009.
Dr. Duker showed his experience in 13 patients treated with the Leksell Gamma Knife (Elekta) who had a minimum follow-up of 6 months. These patients had tumors too large to plaque or too close to the optic nerve, or they chose not to have surgery.
Twelve of the patients achieved local control, and one required enucleation. Two patients died of metastatic disease, and three had visual acuity of 20/200 or better at last follow-up.
The Gamma Knife, which is available at 120 sites in the United States and 136 sites internationally, is a collimated beam of 201 points of gamma rays that are focused at the site of the tumor.
"By having the entry of these beams be divergent, you're minimizing the tissue reaction of the area outside the tumor," Dr. Duker said.
When using this technology in the eye, he said four steps should be taken: retrobulbar block, diagnostic imaging, treatment planning with proprietary software and then treatment.
Advantages of the procedure are that it does not require a large, expensive particle accelerator such as a proton beam treatment; there is no surgery required; it is a single session treatment; and it is more widely available than proton beam.
"Chances are, in your town and perhaps in your local hospital, Gamma Knife is available. There's a lot of experience with this. The problem is the experience is very limited in choroidal melanoma," Dr. Duker said.