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Ekaterina Semenova, Paul Finger; Plaque Radiation Therapy for Large and Extra-large Choroidal Melanoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4235. doi: https://doi.org/.
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To evaluate outcomes (vision, local control, complications) after ophthalmic plaque radiation therapy for large uveal melanomas.
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).
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.
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.
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