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M. Freistuehler, H. Akgül, D. Flühs, W. Sauerwein, M. Marinkovic, B. Jurklies, N. Bornfeld; Brachytherapy Of Juxtapapillary Uveal Melanoma Using Notched Ruthenium-106 Ophthalmic Plaques. Invest. Ophthalmol. Vis. Sci. 2008;49(13):43.
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Treatment of juxtapapillary uveal melanoma with brachytherapy using notched ruthenium-106 ophthalmic plaques. As the goal of brachytherapy of uveal melanomas is destructions of the tumor while saving the eye and possibly in this study prognostic factors were evaluated predicting loss of function and secondary enucleation.
Radiation parameters and follow-up data of a consecutive series of patients with uveal melanoma adjacent to the optic disc were evaluated retrospectively. 203 patients were included into this study. Inclusion criteria were uveal melanoma near to the optic nerve primary treated with brachytherapy using notched ruthenium-106 ophthalmic plaque (Bebig, Germany).The total patient series was divided into two different groups A and B. Group A consisted of 168 patients where brachytherapy was successfully over the evaluation period while group B consisted of 35 patients with treatment associated complications resulting in secondary enucleation. The mean follow-up period in the whole series was 70 month.
Both groups were similar in most of the study parameters. The number of ancillary treatment procedures was 70% and the need of ancillary tumor destructive treatment procedures was more than 30% in both groups. A tumor thickness of more than 5 mm, tumor localization involving the fovea and the need for a second beta-ray brachytherapy was correlated to a poor prognosis for salvaging the affected eye. Patients with this conditions appeared more often in group B and developed more radiation induced complications than the patients in group A. The most important complications correlated with secondary enucleation were secondary glaucoma, retinal detachment, vitreous hemorrhage and recurrent tumor growth. Secondary glaucoma always resulted in enucleation, vitreous hemorrhage appeared 8 times more frequent and retinal detachment about 24 times more frequent in Group B.
The results demostrated that brachytherapy of juxtapapillary uveal melanoma is complicated and requires more treatment procedures than a single brachytherapy. Tumor control could be achieved using ancillary tumor destructive procedures, but atrophy of the optic nerve and loss of vision was frequent. Prognostic factors like tumor thickness exeeding than 5 mm, larger tumor basal diameter that cannot be covered by a single ruthenium plaque, tumor localization involving the fovea was associated with a higher rate of complications leading to subsequent enucleation.
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