April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Outcomes of Medium Choroidal Melanomas Treated with Eye-Physics Ruthenium Plaque Brachytherapy
Author Affiliations & Notes
  • Andrew Browne
    Ophthalmology, Doheny Eye Institute, Los Angeles, CA
    Ophthalmology, Univ of Southern California, Los Angeles, CA
  • Jesse L Berry
    Ophthalmology, Doheny Eye Institute, Los Angeles, CA
    Ophthalmology, Univ of Southern California, Los Angeles, CA
  • Savita Dadapanai
    RadiationOncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
  • Marta Stevanovic
    Harvard College, Harvard University, Cambridge, MA
  • Thomas C Lee
    Ophthalmology, Doheny Eye Institute, Los Angeles, CA
    Ophthalmology, Children’s Hospital Los Angeles, Los Angeles, CA
  • Melvin Astrahan
    RadiationOncology, Keck School of Medicine, University of Southern California, Los Angeles, CA
  • A. Linn Murphree
    Ophthalmology, Doheny Eye Institute, Los Angeles, CA
    Ophthalmology, Children’s Hospital Los Angeles, Los Angeles, CA
  • Jonathan W Kim
    Ophthalmology, Doheny Eye Institute, Los Angeles, CA
    Ophthalmology, Children’s Hospital Los Angeles, Los Angeles, CA
  • Footnotes
    Commercial Relationships Andrew Browne, None; Jesse Berry, None; Savita Dadapanai, None; Marta Stevanovic, None; Thomas Lee, None; Melvin Astrahan, Eye Physics, LLC (I); A. Linn Murphree, None; Jonathan Kim, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 5085. doi:https://doi.org/
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    • Get Citation

      Andrew Browne, Jesse L Berry, Savita Dadapanai, Marta Stevanovic, Thomas C Lee, Melvin Astrahan, A. Linn Murphree, Jonathan W Kim; Outcomes of Medium Choroidal Melanomas Treated with Eye-Physics Ruthenium Plaque Brachytherapy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5085. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

The Collaborative Ocular Melanoma Study (COMS) established Iodine 125 plaque brachytherapy as the standard eye preservation treatment for medium sized choroidal melanomas in the United States. Plaque Simulator (PS) software guided treatment utilizing Eye Physics (EP) plaques provides optimal treatment by enabling customizable radiation profiles for a variety of tumor shapes and sizes. Berry et. al. recently reported EP customized Iodine-125 therapy with similar results to the COMS Iodine-125 non-custom plaques. Herein we report results from a series of 15 patients treated with EP custom Ruthenium Plaque Brachytherapy.

 
Methods
 

Fifteen patients with medium sized choroidal melanomas (2.84-5.5 mm in apical height and a basal diameter of 7.8-12.6mm) treated with ruthenium-based brachytherapy from 2003-2005 were evaluated in a retrospective chart review. Baseline and follow-up data were collected and evaluated for: tumor height, best corrected visual acuity, radiation retinopathy, radiation optic neuropathy, post-radiation cataract formation, diplopia and ptosis. Tumor response kinetics for EP ruthenium plaques, EP iodine plaques were evaluated and compared.

 
Results
 

Incidences of adverse radiation effects were documented: optic neuropathy (6.7%), retinopathy (20%), and cataracts (33%) (Table). Tumor height after therapy demonstrated regression profiles equivalent to tumors treated with Iodine-125 plaques. Five year tumor heights for radiation treated tumors were approximately 0.61 +/- 0.29 (iodine, n=16) and 0.53 +/- 0.17 (ruthenium, n= 6) relative to their heights at diagnosis (Figure).

 
Conclusions
 

This patient subset had background characteristics very similar to those from the COMS and patients treated with EP iodine-125 plaques. Treatment response was equivalent and radiation complications occurred slightly less frequently than those patients treated with iodine-125 radiation. Tumors treated with EP brachytherapy shrink to about 50-60% of their initial height at diagnosis. EP plaque brachytherapy demonstrates similar results with COMS plaques regardless of radiation source.

 
 
Table: a. Baseline characteristics of patients b. Tumor response and clinical outcomes.
 
Table: a. Baseline characteristics of patients b. Tumor response and clinical outcomes.
 
 
Figure: Tumor response to plaque brachytherapy with Iodine (blue) and Ruthenium (Green). The subgroup of patients who were treated with Iodine and developed metastasis are plotted in Red.
 
Figure: Tumor response to plaque brachytherapy with Iodine (blue) and Ruthenium (Green). The subgroup of patients who were treated with Iodine and developed metastasis are plotted in Red.
 
Keywords: 589 melanoma • 671 radiation therapy • 670 radiation damage: light/UV  
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