Abstract
Purpose :
Large choroidal melanoma are often treated with primary enucleation. Globe-sparing plaque brachytherapy may offer a feasible solution for visual preservation. The goal of this study is to measure outcomes after plaque brachytherapy and silicone oil tamponade in large choroidal melanoma
Methods :
This was a retrospective case series of consecutive patients with large-sized choroidal melanoma (defined as tumor height greater than 10mm or greatest basal diameter greater than 16mm) within the period of 2014 to 2020 from a single university academic center. All patients were treated with plaque brachytherapy with vitrectomy and silicone oil, the latter of which was removed on average 7.1 months after primary procedure.
Results :
51 patients with large choroidal melanoma who underwent plaque brachytherapy and silicone oil tamponade were identified and included. Patients completed either iodine-125 seed (n=44) or palladium-103 (n=7) plaque therapy. Mean tumor height was 8.1±2.9 mm (range 2.7 – 12.9mm) and mean greatest basal diameter was 16.9±1.7 mm (10.8 – 20.1mm). Latest follow up time averaged 3.3 years (40 months) following removal of silicone oil tamponade. Recurrence of tumor was detected in 6 patients (11%) and all were re-treated successfully with plaque therapy. The rate of metastasis was 37%. 58% required anti-VEGF or steroid intravitreal injections for radiation retinopathy and/or inflammatory symptoms. Neovascular glaucoma developed in 9% and secondary non-neovascular glaucoma in 33%. Despite these complications, only 8% of patients required enucleation. The overall survival rate was 86% at last follow up and of patients who did not require enucleation, 48% had vision 20/800 or better.
Conclusions :
Plaque brachytherapy with silicone oil tamponade instead of enucleation may be a feasible option for the treatment of patients with large choroidal melanoma, at experienced centers. Immediate vision loss as a result of enucleation, may be avoided.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.