Purchase this article with an account.
Milena L. Cavalcante, Nisha V. Shah, Steven K. Houston, III, Timothy G. Murray, Arnold M. Markoe; Evaluation of Learning Curve for 125-Iodine Plaque Brachytherapy Placement: A 19 Year Review. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3406.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To evaluate the plaque repositioning rates in brachytherapy placement for posterior uveal melanoma using intra-operative echography as a standardized assessment.
An IRB approved, retrospective chart review of 250 consecutive patients undergoing plaque placement for posterior uveal melanoma from 2002-2004 (Group 1) and from 2008-2009 (Group 2) was conducted at Bascom Palmer Eye Institute. Data for the initial subset (Control Group) was acquired from a previous study with an interval from 1992-1995. The incidence of intra-operative plaque repositioning, verified by intra-operative echography, and performed by a single surgeon, at a single service, was reviewed for two decades.
From 1992-1995 (Control Group), 29 patients were evaluated for 125-I plaque brachytherapy placement. From 2002-2004 (Group 1), 100 patients were evaluated, and from 2008-2009 (Group 2), 150 cases were reviewed. The Control Group showed a plaque reposition incidence of 21%, while Groups 1 and 2 showed incidences of 12% and 4%, respectively. 100% of all plaques were appropriately positioned utilizing echography. A surgical volume of 595 was determined to reach a >90% precision rate. Time to Mastery, defined as accuracy >90%, was 297.5 hours of surgery time.
This study suggests that a learning curve exists for placement of I-125 Scleral Plaques for uveal melanoma. The positive trend of tumor-apposition rates for the three groups in this study were 79%, 88%, and 96% respectively, which was statistically significant (p=0.0007). The Time to Mastery observed in this study illustrates the challenges of acquiring precise surgical technique. Intra-operative ultrasound verification for plaque placement remains an important long-term tool, enhancing correct plaque brachytherapy placement.
This PDF is available to Subscribers Only