Abstract
Purpose: :
To report our experience in long-term follow-up of ocular melanoma patients treated with the Nag custom 125I plaque.
Methods: :
Retrospective chart review of 97 ocular melanoma patients treated with Nag plaque brachytherapy at The Ohio State University Medical Center from 1994 to 2009.
Results: :
Mean age at presentation was 63 (range 22-93). Mean follow-up was 67 months (range 2-180). Mean radiation dose at the prescription point was 8646 cGy (range 5176-15789). Using the AJCC criteria, 32% of tumors were classified as T1, 48% T2, and 20% T3. By 67 months, 26% of eyes retained visual acuity of 20/40 or better; 22% were 20/50 to 20/200; and 52% were worse than 20/200. The most common treatment-related complications by 67 months were radiation retinopathy (54%); cataract (33%); and radiation optic neuropathy (26%). At 120 months post-brachytherapy, 6 of 20 patients with follow-up data (30%) retained visual acuity of 20/40 or better, 4 (20%) were 20/50 to 20/200, and 10 (50%) were worse than 20/200. In this series, 6% had local recurrences at a mean of 48 months (range 15-154), while 7% of patients had distant metastases at a mean of 57 months (range 19-82). In the COMS trial, visual acuity at the 3-year follow-up measured 20/40 or better in 34% of eyes and 20/200 or worse in 45%. At 5 years, radiation retinopathy characteristics were found in up to 92% of patients, cataract developed in 68%, and radiation optic neuropathy maximum prevalence was 27.4%. Rate of local treatment failure was 10.3% and distant metastasis was 25%.
Conclusions: :
The Nag custom 125I plaque is an effective treatment for uveal melanoma, with preservation of useful visual acuity (20/200 or better in 48% and 20/40 or better in 26% of eyes) at 5 years after treatment. The visual acuity and complication data are similar to those reported in COMS, with a lower rate of radiation retinopathy at 5 years.
Keywords: melanoma • radiation therapy