Abstract
Purpose:
To evaluate outcomes (vision, local control, complications) after ophthalmic plaque radiation therapy for large uveal melanomas.
Methods:
We evaluated the results of ophthalmic plaque brachytherapy of 48 patients with American Joint Committee on Cancer (AJCC) T3 and T4 uveal melanomas treated within the period of 2002-2012 (with a minimum follow up of 6 months). Pretreatment comparative dosimetry studies resulted in the use of palladium-103 (n=47) or iodine-125 seed (n=1) sources. The mean dose to the tumor apex was 69 Gy (range 49-87Gy).
Results:
Plaque radiotherapy provided local tumor control in 91.7% and eye retention in 89.6% of patients at a mean 4 years observation (range 6 to 125 months). The most common long-term brachytherapy-related complications were radiation retinopathy (66.7%) and radiation optic neuropathy (47.9%) developing 5 to 36 months after brachytherapy (mean 19 months). These complications were typically stabilized by periodic bevacizumab or ranibizumab intravitreal injections. Secondary cataract developed in 36.4% phakic eyes within 2-45 months after irradiation (mean 26 months). Pre-existing and persistent exudative retinal detachments were observed in 29.2% and were the major cause of vision loss. Iris neovascularization developed in 18.8% of the patients and secondary glaucoma in 16.6% requiring enucleation in 3 patients (6.3%). In this series 54.2% patients maintained 20/200 or better vision. Metastasis developed in 31.3% of patients.
Conclusions:
In this series, palladium-103 plaque radiotherapy offered superior local control, visual acuity and eye retention rates as compared to those reported in the literature.
Keywords: 589 melanoma •
671 radiation therapy •
754 visual acuity