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Stereotactic Photon Beam Radiation Case Study

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Discussion
In the last decades the management of patients with uveal melanoma has changed towards globe sparing techniques. Alternatives to the radical enucleation vary from observation to transpupillary thermotherapy, block-excision, and endoresection with pars plana vitrectomy, brachytherapy using a variety of radioisotopes, radiotherapy, Leksell Gama Knife and stereotactic radiosurgery (Henderson et al. 2006; Dieckmann et al. 2006; Mosci et al. 2009).
Stereotactic photon beam irradiation has been under clinical investigation for the treatment of uveal melanoma for over 15 years. The efficacy of SRS for uveal melanoma has been proven in different studies with local tumor control rates reported over 90 % (Mueller et al. 2000; Dieckmann et al. 2003; Krema et al. 2009). High rates of local control can be also achieved with 5-year control rates exceeding 95 % in patients treated with proton-beam irradiation (Meyer et al. 2000). Reported case series suggest that SRS can have similar local tumor control rate, metastasis rate, mortality rate and complications rate when compared to brachytherapy. The findings in the series suggest a role of SRS in the treatment of selected cases of uveal melanoma (Seddon et al. 1990; Ghazi et al. 2008).
LINAC based stereotactic irradiation for uveal melanoma is feasible and well tolerated and can be offered to patients with medium sized and unfavorably located uveal melanoma
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The eye retention is one of the main goals of the conservative treatment, but in some cases enucleation can be indicated due to complications after therapy e.g. secondary neovascular glaucoma (Furdova et al. 2005).
According to our results a single one-day session SRS with 35.0 Gy is sufficient to treat small and medium stage melanoma (Furdova et al.
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