{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:10:51Z","timestamp":1792793451630,"version":"4.5.0"},"reference-count":64,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T00:00:00Z","timestamp":1664323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The main objective of this prospective observational study was the characterization of the feasibility and early outcome of image-guided (IG) volumetric modulated arc (VMAT) radiosurgery (SRS) followed by resection for patients with large intraocular melanoma. Our study included consecutive patients with unfavorable-risk melanoma, enrolled in an ophthalmic oncology center. IG-VMAT-SRS was applied by high-resolution 4D image guidance and monitoring. Current stereotactic technique parameters were evaluated for comparison. Side effects and eye function, based on a 5-point CTC assessment score, were quantified. In patients with tumors located more than 0.7\u20131 mm apart from the optic nerve, partial to complete volume-sparing of the optic nerve head could be achieved. In 95.5% of this subgroup, the vitality of the optic nerve and vision could be preserved by the multimodality-treatment approach (mean follow-up: 18 months (7.5\u201336 months)). The advanced technology of stereotactic radiotherapy demonstrated the achievability of steep dose gradients around the high-dose volume, with 4D-IG-VMAT dose application. These results enforce IG-VMAT-SRS followed by resection as one of the major therapeutic options for patients with large intraocular melanoma. The combination of 4D-IG high-precision SRS and resection provides an effective treatment for large intraocular melanoma, with few side effects, and enables an eye bulb and even vision preserving modus operandi.<\/jats:p>","DOI":"10.3390\/cancers14194729","type":"journal-article","created":{"date-parts":[[2022,9,28]],"date-time":"2022-09-28T20:58:47Z","timestamp":1664398727000},"page":"4729","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Feasibility, Method and Early Outcome of Image-Guided Volumetric Modulated Arc Radiosurgery Followed by Resection for AJCC Stage IIA\u2013IIIB High-Risk Large Intraocular Melanoma"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3218-0539","authenticated-orcid":false,"given":"Maja","family":"Guberina","sequence":"first","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekaterina","family":"Sokolenko","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nika","family":"Guberina","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sami","family":"Dalbah","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9224-9318","authenticated-orcid":false,"given":"Christoph","family":"P\u00f6ttgen","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"L\u00fcbcke","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Indenk\u00e4mpen","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfred","family":"Lachmuth","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Fl\u00fchs","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9262-7289","authenticated-orcid":false,"given":"Cornelius","family":"Deuschl","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic, Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyla","family":"Jabbarli","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7868-5167","authenticated-orcid":false,"given":"Miltiadis","family":"Fiorentzis","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Foerster","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3621-9007","authenticated-orcid":false,"given":"Philipp","family":"Rating","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Ebenau","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Grunewald","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Bechrakis","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Stuschke","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany"},{"name":"German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Hufeland Str. 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.brachy.2013.11.008","article-title":"The american brachytherapy society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma","volume":"13","author":"Force","year":"2014","journal-title":"Brachytherapy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1001\/jamaophthalmol.2017.3805","article-title":"Long-term 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