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J. Pe'er, S. Frenkel, K. Hendler, I. Kaiserman, N. Kaiserman; Ruthenium-106 Plaque Therapy for Posterior Uveal Melanomas Thicker Than 8 mm. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5760.
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Ruthenium-106 brachytherapy is considered an effective method of treatment for small- to medium-sized melanomas, up to a thickness of 7 mm. The purpose of this study was to examine the effectiveness and safety of Ruthenium-106 plaque brachytherapy in the management of posterior uveal melanomas thicker than 8 mm.
One hundred twenty-six consecutive patients who were diagnosed with thick (apical height ≥ 8.0 mm) uveal melanoma were included. Sixty-three patients primarily treated with Ruthenium-106 plaque brachytherapy were compared to 63 patients primarily treated by enucleation. Kaplan-Meier survival analysis and Cox adjustment were used to measure visual acuity, eye retention, local recurrence, metastases, all-cause mortality, and melanoma-related mortality.
The mean tumor thickness in the brachytherapy group was 9.20 ± 0.90 mm (mean ± SD; range 8.00 - 11.81 mm), compared to 12.23 ± 1.89 mm (range 8.00 - 19.40 mm) in the enucleation group. The 5- and 10-year melanoma-specific mortality rates were 18.7% and 30.0% for brachytherapy patients and 27% and 39.9% for enucleated patients (p = 0.37 and p = 0.33), respectively. When comparing the brachytherapy patients with enucleated patients who had tumors not thicker than 12 mm (32 patients, 10.84 ± 0.87 mm, range 8.00 - 11.72 mm), the 5- and 10-year metastases rates were 31.8% and 38.6% (p = 0.35 and p = 0.91), and the 5- and 10-year melanoma-related mortality rates were 25% and 32.5% (p = 0.65 and p = 0.99), respectively. No significant difference in survival was noted between patients who did and did not develop local recurrence. Of the eyes that were initially treated with brachytherapy, 71.4% were saved from enucleation, which was performed for tumor regrowth and/or complications (neovascular glaucoma). Of the brachytherapy patients whose eye was saved, 62.5% of those for whom we have visual acuity data had best corrected visual acuity (BCVA) of better than 20/200; 43.8% retained BCVA of 20/40 or better.
Ruthenium-106 brachytherapy is an effective and safe alternative to enucleation in treating thick posterior uveal melanomas.
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