Long-term outcomes after enucleation or plaque brachytherapy of choroidal melanomas touching the optic disc

Maria Fili,Melvin Astrahan,Gustav Stålhammar

doi:10.1016/j.brachy.2021.05.162

Maria Fili, Melvin Astrahan + Show 1 more

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https://doi.org/10.1016/j.brachy.2021.05.162

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Abstract

PURPOSETo investigate local and systemic outcomes after enucleation, brachytherapy with ruthenium-106, iodine-125, notched and non-notched plaques and transpupillary thermotherapy (TTT) of choroidal melanomas touching the optic disc. METHODS AND MATERIALSAll patients treated for choroidal melanoma touching the optic disc at St. Erik Eye Hospital, Stockholm, Sweden between 1984 and 2015 (n = 165) were included. Retrospective clinicopathological data was collected and 3D dosimetry performed. RESULTSNinety-five patients (58 %) had been treated with ruthenium-106 brachytherapy, 21 (13 %) with iodine-125 brachytherapy and 49 (30 %) with enucleation. Median follow-up was 12.3 years. In simulations, some tumor areas were underdosed with non-notched plaques. Fifty of 116 patients (43 %) underwent a secondary brachytherapy (n = 5), enucleation (n = 29) or TTT (n = 16). In multivariate Cox Regressions, there were no significant differences in the risk for tumor progression or lack of regression between radioisotopes and notched and non-notched plaques. Adding TTT did not reduce the risk for a second treatment. The number of clock hours of circumpapillary tumor growth did not correlate to the risk for treatment failure or mortality. There were no significant differences in melanoma-related mortality for any treatment including enucleation. Kaplan-Meier disease-specific survival was 77 % at 5 years, 72 % at 10 years and 67 % at 20 years. CONCLUSIONPlaque brachytherapy of choroidal melanomas touching the optic disc entails a two to threefold increased risk for treatment failure. This risk is similar between radioisotopes, notched and non-notched plaque designs and if TTT is used or not. The high rate of treatment failure does not lead to increased mortality.

Highlights

At diagnosis, most patients with choroidal melanoma have medium sized tumors that can be safely treated withReceived 23 March 2021; received in revised form 13 May 2021; accepted 27 May 2021; Available online xxxAbbreviations: AJCC, American Joint Committee on Cancer; AUC, Area under the curve; COMS, Collaborative Ocular Melanoma Study; Gy, Gray; hazard ratios (HR), Hazard ratio; proton beam radiation therapy (PBRT), Proton beam radiation therapy; PDT, Photodynamic therapy; ROC, Receiver operating characteristics; SD, Standard deviation; transpupillary thermotherapy (TTT), Transpupillary thermotherapy.eye-preserving plaque brachytherapy [1,2]
Of the 21 patients treated with iodine-125, all had been treated with CCB plaques (Fig. 1)
TTT was added to the primary brachytherapy for 49 of 116 patients (42 %)

Summary

Introduction

Most patients with choroidal melanoma have medium sized tumors that can be safely treated withReceived 23 March 2021; received in revised form 13 May 2021; accepted 27 May 2021; Available online xxxeye-preserving plaque brachytherapy [1,2]. Eye plaques are commonly shaped as concave discs that are temporarily sutured to the sclera overlying the tumor. Their inner surface contains seeds or foils of radioisotopes such as iodine-125, ruthenium-106 or Palladium-103 and their outer surface is commonly shielded by a precious metal such as silver or gold (3−5). In the ageing but still very relevant Collaborative Ocular Melanoma Study, local treatment failure after plaque brachytherapy, defined as intraocular tumor growth, recurrence or extraocular extension, was observed in 10 % of patients [6,1]. Thirteen percent of patients had undergone post brachytherapy (secondary) enucleation. Similar rates of secondary enucleation have been observed in two of JID: BRACHY 2

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