Abstract
Abstract: :
Purpose: To evaluate changes in tumor height following Pd–103 plaque brachytherapy. Methods: A retrospective chart review was performed on 164 patients with uveal melanoma. One hundred thirty eight eyes had choroidal melanomas and 26 contained anterior uveal melanomas (ciliary body and iris). All patients were treated with Pd–103 ophthalmic plaque radiation therapy during one brachytherapy session of 5–7 days. After an initial pre–operative evaluation, patients were typically measured at 4 month post–operative intervals. Patients with follow–up less than one year were eliminated from the study (n=17). We report on a follow–up period ranging from a minimum of 12 months to 154 months (mean =52 months). Results: After irradiation, the uveal melanomas initially decreased in apical height in all 147 cases (100%). The overall mean regression in apical height was 51.9% (range 9.1% to 91.5%). For the anterior uveal melanomas, the mean regression in apical height was 48.7% (range 18.2 – 86%). For the posterior choroidal melanomas, the mean regression in apical height was 52.5% (range 9.4 to 91.5%). Five patients, after initially regressing, experienced tumor regrowth so that overall local control (no tumor recurrence) rate was 96.6%. The overall survival rate from all causes was 91.2%, but 94.6% when related only to metastatic melanoma. Patients with the largest amount of overall regression (>60%) had the best overall survival; however, there was also a relationship between poor survival and fast regression in apical tumor height (6 and 12 months). Conclusion: Palladium–103 plaque radiation therapy of both anterior and posterior uveal melanomas resulted in long–term regression in apical height. While significant tumor regression was noted, most eyes contained residual tumor tissue. Though we have found apical height to be an excellent indicator of response to irradiation, the tumors' basal diameter, internal reflectivity and shape should also be followed.
Keywords: melanoma • radiation therapy • tumors