Retrospektive Analyse einer Dosisverteilung, dosisbezogene Komplikationen und Quantifizierung der Ergebnisse einer Brachytherapie mit Ruthenium-Applikatoren (Rh-106) bei posterior gelegenen Aderhautmelanomen.
Des Weiteren ist die Weiterentwicklung des Therapieplanungssystems für die
Augentumortherapie mit 106Ru-Brachytherapie geplant. Das Ziel der genauen
Therapieplanung dient einer Verbesserung der Präzision der Brachytherapie und
ermöglicht eine aussagekräftige Prognose in Bezug auf die visusbedrohlichen
Komplikationen. Dies ist für den Patienten noch vor Therapiebeginn hoch relevant. Mit adäquater Dosisanpassung, optimaler Applikatorlage, akkurater Patientenselektion sowie einer individuellen Planung sind noch bessere Ergebnisse der Brachytherapie zu erzielen und die Zufriedenheit der Patienten ist bei exzellenter Tumorkontrolle und akzeptabler Komplikationsrate gesichert.
Ruthenium-106 brachytherapy is an established form of therapy used for small and medium-sized choroidal melanoma (CM). High-quality evidence based studies concerning safety and dose distribution, however, do not yet exist for this form of treatment.The aim of this study is to examine the treatment results of ruthenium-106 brachytherapy in cases of CM depending on the locally applied dose distribution - especially with regard to radiation retinopathy and optic neuropathy, as well as relevant prognostic factors. One particular aspect was working out a retrospective analysis of tumor control and side effects in relation to the physical parameters. Another one was the development of suggestions for the treatment plan that can help minimize harmful side effects while maintaining optimal tumor control. Furthermore, we tried to answer questions that can not be resolved using the usual retrospective design - for example what the optimal distribution of the radiation dose or the optimal treatment in the case of complications is. This was possible using an original software based on physical basics. The approach can be reviewed and confirmed by means of the retrospective analysis within the study. Our software enables the user to reconstruct the position of the applicator during the treatment with minimal deviation in the localization using the position of the radiation scar (visible in the fundus image) and the known sclera dose. This allows for evaluation of the exact dosage distribution after radiation. This way, we were able to confirm that the mean dose applied to the critical structures (papilla, macula) as well as the characteristics of the tumor (angle to the papilla, macular involvement) play an essential role. Additionally, further development of the system for therapy planning for the eye tumor treatment using ruthenium-106 brachytherapy is planned. Exact therapy planning would improve the precision of brachytherapy and allow for a conclusive prognosis concerning sight-threatening complications. This is highly relevant for the patient even before the start of the treatment. Implementing an adequate dose adjustment, optimal applicator location, accurate patient selection as well as an individual plan, brachytherapy can achieve even better results. Patient satisfaction can be ensured with excellent tumor control and an acceptable complication rate.