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Kimberly Chin, Ekaterina Semenova, Paul Finger; Radiation Therapy for Small Choroidal Melanoma: 10-years Experience with Palladium-103 Plaque Radiation Therapy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4234. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate outcomes (vision, local control, complications) after ophthalmic plaque radiation therapy for small choroidal melanomas.
Ninety one patients with small choroidal melanomas (<2.5 mm apical height and <10 mm wide) were treated with palladium-103 plaque brachytherapy between 2002-2012. Pre-operative tumor thickness ranged from 1.5 to 2.5 mm (mean 2.2 mm, CI 2.1-2.3 mm). Tumor base diameters ranged from 5.5 to 10.0 mm (mean 8.4 mm, CI 8.2-8.7). Thirty one patients (34.1%) in this study were observed for change from 2 months to 16 years prior to radiation treatment.
Plaque radiotherapy provided local tumor control in 98.9% at a mean 55 months of observation (95% CI 48-62 months). One patient failed treatment. Mean tumor apex dose was 82.3Gy (range 70.0-102 Gy). The most common long-term brachytherapy-related complications were radiation retinopathy (47.3%) and radiation optic neuropathy (19.8%) developing 9 to 72 months after brachytherapy (mean 26 months). These complications were typically stabilized by periodic anti-VEGF intravitreal injections. In this series 85 patients (93.4%) maintained 20/200 or better vision. Metastasis developed in one patient (1.1%).
These findings support palladium-103 plaque radiotherapy as an effective method to treat small choroidal melanomas. While informed consent plays a critical role in small melanoma case selection, treated patients should expect excellent local control rates and better visual acuity outcomes compared to treatment of larger choroidal melanomas.
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