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Rachel E. Reem, Mersiha Hadziahmetovic, Douglas Martin, Frederick H. Davidorf, Ashraf M. Mahmoud, Colleen M. Cebulla; Long-term Outcomes Of Ocular Melanoma Patients Treated With Custom-made Nag Plaques For 125I Brachytherapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3403.
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To report our experience in long-term follow-up of ocular melanoma patients treated with the Nag custom 125I plaque.
Retrospective chart review of 97 ocular melanoma patients treated with Nag plaque brachytherapy at The Ohio State University Medical Center from 1994 to 2009.
Mean age at presentation was 63 (range 22-93). Mean follow-up was 67 months (range 2-180). Mean radiation dose at the prescription point was 8646 cGy (range 5176-15789). Using the AJCC criteria, 32% of tumors were classified as T1, 48% T2, and 20% T3. By 67 months, 26% of eyes retained visual acuity of 20/40 or better; 22% were 20/50 to 20/200; and 52% were worse than 20/200. The most common treatment-related complications by 67 months were radiation retinopathy (54%); cataract (33%); and radiation optic neuropathy (26%). At 120 months post-brachytherapy, 6 of 20 patients with follow-up data (30%) retained visual acuity of 20/40 or better, 4 (20%) were 20/50 to 20/200, and 10 (50%) were worse than 20/200. In this series, 6% had local recurrences at a mean of 48 months (range 15-154), while 7% of patients had distant metastases at a mean of 57 months (range 19-82). In the COMS trial, visual acuity at the 3-year follow-up measured 20/40 or better in 34% of eyes and 20/200 or worse in 45%. At 5 years, radiation retinopathy characteristics were found in up to 92% of patients, cataract developed in 68%, and radiation optic neuropathy maximum prevalence was 27.4%. Rate of local treatment failure was 10.3% and distant metastasis was 25%.
The Nag custom 125I plaque is an effective treatment for uveal melanoma, with preservation of useful visual acuity (20/200 or better in 48% and 20/40 or better in 26% of eyes) at 5 years after treatment. The visual acuity and complication data are similar to those reported in COMS, with a lower rate of radiation retinopathy at 5 years.
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