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Introduction: This study reports the long-term outcomes in patients affected by uveal melanoma (UM) treated with ruthenium-106 ( 106 Ru) plaque bra-chytherapy (BT)., Material and Methods: From May 2005 to January 2024, 127 patients (median age: 69 years, range: 32-90 years) affected by small and medium UM were treated with 106 Ru plaque BT at the University Hospital of Pisa. All the patients were treated with 106 Ru plaque BT with a prescription dose of 110 Gy to the tumor apex., Results: Inclusion criteria comprised Eastern Cooperative Oncology Group performance status ≤ 2, life expectancy > 6 months, and tumor thickness ≤ 6 mm and/or diameter ≤ 16 mm. The 5-year rate of local control, progression-free survival, metastasis-free survival, and overall survival were 95.2%, 85.4%, 93.0%, and 95.9%, respectively. Local progression was recorded in nine patients (7.1%): two of them (1.6%) had also distant metastasis. Seven patients were retreated with photon beam and one patient with proton beam stereotactic radiosurgery; one patient was retreated with 125 I plaque BT. Only one patient underwent enucleation for large local progression after about 10 years. Thirty-four patients (26.8%) had one or more acute and late toxicities. No grade 4 acute or late toxicity was reported., Conclusions: This study suggests that 106 Ru plaque BT is a successful and well-tolerated radiotherapy technique in the management of UM., Competing Interests: None., (Copyright © 2024 Termedia.)

Introduction: To evaluate and report the outcome of a patient with locally recurrent uveal melanoma (UM) previously treated with brachytherapy (BT), using a second personalized globe-sparing radiotherapy approach., Material and Methods: In June 2020, a 78-year-old man arrived at our institution with diplopia and suspected uveal melanoma. At the ophthalmological evaluation (B-scan and A-scan ultrasonography) a lesion in the right eye at 6-7 hours of about 5 mm thickness, with internal lacunar areas, approximately 7 mm away from the limbus, was observed. The patient underwent ruthenium plaque BT at a total dose of 110 Gy prescribed to the apex of the tumour. At the follow-up, the lesion was under control until September 2021, but it recurred with a satellite exudative detachment in the lower and temporal sectors 7-10 hours. At the B-scan the lesion had a maximum thickness of 4.6 mm. Subsequently, in a multidisciplinary discussion, one single fraction stereotactic radiosurgery was scheduled. The prescribed dose was 27 Gy in the de-novo lesion and 24 Gy in the previously irradiated site. Stereotactic radiosurgery was performed in October 2021., Results: The time interval between the 2 treatments was 15 months. Twenty months after recurrence, local tumour control was observed, and no metastases were detected on follow-up examinations. No severe acute or late toxicity was observed due to the retreatment., Conclusions: Photon stereotactic radiotherapy is a feasible, acceptably tolerated modality, and it represents an eye-preserving treatment also for patients with recurrent UM unfit for BT., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Termedia.)

Aim of the Study: The aim of this retrospective study was to analyse tumour control, toxicity, and aesthetic outcome of patients affected by non-melanoma skin cancer (NMSC) treated with 192 Ir high-dose-rate (HDR)-brachytherapy (BT) at the Division of Radiotherapy, University of Pisa., Material and Methods: From January 2014 to December 2019 we treated 37 patients (median age 79 years; range 31-91 years) affected by NMSC, with the following histological subtypes: 62.2% basal cell carcinoma and 37.8% squamous cell carcinoma. We analysed 40 lesions with a depth ≤ 5 mm, located in 40.0% scalp, 17.5% nose, 25.0% face, and 17.5% ear, all treated with 192 Ir-based HDR-BT, using tailored custom moulds, with a median of 5 catheters (range, 1-9) spaced 1 cm apart. The most common fractionation scheme was 40 Gy in 8 daily fractions; the biological effective dose was 60 Gy., Results: The median follow-up was 25 months (range, 3-70 months). The 2-year local control rate was 90%. Common terminology criteria for adverse event (CTCAE vs. 5.0) G1 toxicities were dermatitis (52%), pain (25%), and ulceration (22%). The only G2 acute toxicities were dermatitis and ulceration. The most common G1 late toxicities were fibrosis (17%), atrophy (15%), and hypopigmentation (12%). No G3 or higher acute or late toxicity was reported. Excellent cosmetic results were observed in 65.0% of the lesions; only 1 case (2.5%) reported a poor cosmetic result., Conclusions: Surface mould HDR-BT is a safe, effective, and well tolerated treatment modality for NMSC and can be considered a good alternative, especially for elderly patients who are often unfit for surgery., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Termedia.)

Vismodegib is playing an increasing role in the treatment of locally advanced or metastatic basal cell carcinoma (BCC) that is not a candidate for surgery or radiotherapy, and also in radiation-induced BCC. A 22-year-old man with a history of Hodgkin lymphoma, nodular sclerosis stage IIA, from October 1994 to February 1995 treated with 25 mg/m 2 doxorubicin, 10 IU/m 2 bleomycin, 6 mg/m 2 vinblastine, and 375 mg/m 2 dacarbazine for four cycles, followed byconformal beam radiotherapy (EBRT) on laterocervical, supraclavear, and mediastinal nodes up to a total dose of 30 Gy and following EBRT boost on mediastinal nodes up to a dose of 10 Gy. Subsequently, the patient underwent conformal EBRT on lomboaortic nodes up to total dose of 30 Gy at the University Hospital of Pisa until May 1995. There was no evidence of disease, until March 2012 when the patient developed severalBCCs, occurring in the field of prior radiation, treated with local excisions. No mutations of Hedgehog (Hh) pathway or other genes were found and nevoid basal cell carcinoma syndrome was not diagnosed. In February 2018, the patient began therapy with vismodegib at standard dose of 150 mgorally daily and was treated for 10 months, with low adverse events and with pathological complete response of disease until July 2019. This experience shows that there are, however very few, BCCs not associated with genetic disorders. Vismodegib seems to be an effective and safe therapeutic approach also for radiation-related BCCs, associated with relatively low toxicity., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 Termedia.)