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Michael Freistuehler, Eva Biewald, Mete Goek, Theodora Gkika, Norbert Bornfeld, Dirk Fluehs, Wolfgang Sauerwein; Brachytherapy of large uveal melanomas. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3405.
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To assess the outcome and treatment related complications of large uveal melanomas of 6.5 - 8.0 mm thickness using either a Ru106-plaque or a Ru106-I125-bi-nuclide-plaque.
Retrospective evaluation of the radiation protocol and the follow up of patients with large uveal melanomas. The criteria blindness was defined as finger counting and less. study patients: n = 435, inclusion criteria: large uveal melanomas treated with brachytherapy using Ru106-plaques (n=338) or Ru106-J125-bi-nuclide plaques (n=97), tumor height between 6.5 mm and 8.0 mm, median follow-up 42,7 month.
In 90% of all cases a total regression of the uveal melanoma and the induction of a radiation scar could be achieved. Secondary enucleation had to be performed in about 10% and was nearly in all cases the result of large tumor diameter, the need of a second plaque, loss of vision and tumor control. Both groups differed in decreasing of visual acuity. The Ru106-group had a better outcome of visual acuity than the Ru106-J125-bi-nuclide group. Furthermore the study showed that tumor localization close to the optic disc and the use of notched plaques were the most important factors predicting poor outcome.
Brachytherapy of large uveal melanomas has a high morbidity due to tumor volume and radiation doses needed to destroy the tumor. Ru106-plaques have a limited tissue penetration and are routinely used for local radiation of tumors not exceeding 6.5 mm thickness. Thicker tumors result in radiation doses delivered to the sclera as high as 1500 Gy. Adding I125 has the advantage of deeper tissue penetration and a lower sclera contact dose but results in higher morbidity because of retinal complications and secondary glaucoma. In conclusion high dose brachytherapy with Ru106-plaques has better final outcomes in local radiotherapy of large uveal melanomas not exceeding 8.0 mm thickness compared to gamma ray sources with a deeper tissue penetration. Tumor localization close to the optic disc is a significant risk factor for secondary enucleation.
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