Abstract
Purpose::
To report the use and outcomes of a novel 2 mm thick, slotted I125 episcleral plaque that collimates each I-125 seed individually resulting in more homogeneous dose to the tumor and underlying sclera and significantly reduced lateral radiation spread to uninvolved structures compared to other plaque designs.
Methods::
Retrospective chart review of tumor characteristics, imaging studies and visual outcomes after slotted plaque treatment.
Results::
Seven eyes of seven patients diagnosed with larger medium (height greater than 6 mm) and large choroidal melanomas (height > 8 mm)) were treated with the slotted plaque between 1998 and 2006. Patients ranged in age from 24 to 89 years old (median 63 years). Eighty-five Gy was delivered to the apex of each tumor, and the plaque was removed on average at seven days. Length of follow-up ranged from 30 to 66 months (median 49 months). Median tumor size decreased from 7.50 mm (6.20 to 9.10 mm) pre-operatively to 3.06 mm (1.65 to 7.80 mm) at the last visit. Median visual acuity was 20/50 (20/25 to CF at 2ft) on presentation, and was CF at 2 ft (20/100 to HM) at the last follow up. One eye developed tumor recurrence. One successfully treated choroidal tumor patient developed a lung metastasis at five-years follow-up. There were no deaths at four-years follow-up.
Conclusions::
The large choroidal tumors were successfully treated with the episcleral slotted plaque. The local recurrence and metastasis rates (14.3% in an average of 3 years) were relatively low in these patients with large choroidal melanomas.
Keywords: melanoma • tumors • radiation therapy