A choice of radionuclide: Comparative outcomes and toxicity of ruthenium-106 and iodine-125 in the definitive treatment of uveal melanoma

Abstract

PurposeBoth iodine-125 (125I) Collaborative Ocular Melanoma Study and ruthenium-106 (106Ru) eye plaques can achieve excellent tumor control in patients diagnosed with uveal melanoma. We analyzed our single institutional experience in the management of ocular melanoma treated with either 125I or 106Ru plaque brachytherapy. Methods and materialsThe records of 107 patients with uveal melanoma treated with either 106Ru (n = 40) or 125I (n = 67) plaque brachytherapy between 2000 and 2008 were retrospectively reviewed. Tumor control parameters and toxicity were assessed. ResultsActuarial 5-year rates of local control, progression-free survival, and overall survival with 106Ru were 97%, 94%, and 92%, respectively. For 125I, these values were 83%, 65%, and 80%. In the subset of patients with tumor apex height ≤5 mm (36 125I and 40 106Ru), there was no difference in overall survival; however, progression-free survival was significantly improved with 106Ru (P = .02). Enucleation-free survival was significantly different between the 2 subsets, with no enucleations in the 106Ru cohort (P = .02). Patients treated with 106Ru experienced reduced retinopathy (P = .03) and cataracts (P < .01). ConclusionsBoth 125I and 106Ru eye plaque brachytherapy treatment result in encouraging tumor control for patients with uveal melanoma. We demonstrate that 106Ru offers these benefits with reduced toxicity in patients treated for uveal melanomas ≤5 mm in apical height.