July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Adjuvant brachytherapy with strontium-90 or ruthenium-106 in conjunctival melanoma
Author Affiliations & Notes
  • Niels J Brouwer
    Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
  • Marina Marinkovic
    Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
  • Femke P Peters
    Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
  • Maarten C Hulshof
    Radiation Oncology, Amsterdam Medical Center / University of Amsterdam, Amsterdam, Netherlands
  • Bradley R Pieters
    Radiation Oncology, Amsterdam Medical Center / University of Amsterdam, Amsterdam, Netherlands
  • Rob J W de Keizer
    Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
  • Nanda Horeweg
    Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
  • Mirjam S Laman
    Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
  • Jaco C Bleeker
    Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
  • Sjoerd G van Duinen
    Pathology, Leiden University Medical Center, Leiden, Netherlands
  • Martine J. Jager
    Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
  • Carien L Creutzberg
    Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
  • Gregorius P M Luyten
    Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
  • Footnotes
    Commercial Relationships   Niels Brouwer, None; Marina Marinkovic, None; Femke Peters, None; Maarten Hulshof, None; Bradley Pieters, None; Rob de Keizer, None; Nanda Horeweg, None; Mirjam Laman, None; Jaco Bleeker, None; Sjoerd van Duinen, None; Martine Jager, None; Carien Creutzberg, None; Gregorius Luyten, None
  • Footnotes
    Support  LUMC MD/PhD-programme grant
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 3627. doi:
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      Niels J Brouwer, Marina Marinkovic, Femke P Peters, Maarten C Hulshof, Bradley R Pieters, Rob J W de Keizer, Nanda Horeweg, Mirjam S Laman, Jaco C Bleeker, Sjoerd G van Duinen, Martine J. Jager, Carien L Creutzberg, Gregorius P M Luyten; Adjuvant brachytherapy with strontium-90 or ruthenium-106 in conjunctival melanoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3627.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Limited data are available on the outcome of different brachytherapy modalities in conjunctival melanoma, as the disease is rare and data is often pooled for statistical purposes. This study evaluates and compares the clinical outcome of adjuvant brachytherapy with either Strontium-90 or Ruthenium-106 in conjunctival melanoma.

Methods : A retrospective review was performed of the clinical data of 58 patients who received adjuvant brachytherapy after local resection of conjunctival melanoma with either a Sr-90 handheld-applicator or a Ru-106 plaque in the Leiden University Medical Center (the Netherlands) between 1999 and 2016. The protocol with adjuvant Sr-90 was used in our institution until 2012, the protocol with adjuvant Ru-106 was used hereafter for logistical reasons. Local recurrence, metastasis, survival, visual acuity and treatment complications were assessed.

Results : A total of 32 patients were treated with adjuvant Sr-90 and 26 with adjuvant Ru-106. All lesions were epibulbar, with a mean thickness of 1.12 mm and a mean largest basal diameter of 6.82 mm. Mean age at diagnosis was 58.9 years. There were no differences in baseline tumour characteristics between the two groups. Mean follow-up of patients treated with Sr-90 was 113.4 months, and 29.0 months for patients treated with Ru-106. Local recurrence occurred in 8 cases (25%) after Sr-90, and 5 cases (19%) after Ru-106 (p=0.60), with 3- and 5-year recurrence rates of 16% and 19%, versus 32% and 32%, respectively (p=0.45). Metastasis developed in 2 cases (6%) after Sr-90, and 1 patient (4%) after Ru-106 (p=1.00), with 3- and 5-year metastasis rates of 3% and 7%, versus 4% and 4%, respectively (p=0.83). Melanoma-related death was seen in 3 patients (9%) after Sr-90 treatment, and in none after Ru=106 treatment (p=0.25). Most reported overall complications were pain or discomfort (29%), dry eye symptoms (21%), symblepharon (9%), ptosis (12%) and cataract (7%). No severe corneal or scleral problems were observed. Median visual acuity was 20/20 pre-surgery as well as at the end of follow-up, in both treatment groups.

Conclusions : Adjuvant brachytherapy with Sr-90 or Ru-106 provides good tumour control with few side effects in patients with limited conjunctival melanoma. No statistically significant differences in treatment outcome were detected. The choice for either treatment may be based on experience of the clinician and availability of materials.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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