Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy.

Gilda Cennamo,Elide Matano,Antonio Farella,Mario Giuliano,Giovanni Cennamo,Daniela Montorio,Raffaele Liuzzi,Luca D’ Andrea,Maria Angelica Breve,Sabino De Placido

doi:10.3389/fonc.2021.754108

Abstract

Uveal melanoma is the most common primary intraocular malignancy. The aim of this retrospective study was to report the results after ruthenium-106 (Ru-106) plaque brachytherapy for uveal melanoma in terms of tumor control, visual acuity, radiation-related complications, tumor recurrence, metastases, and patients’ survival rate during 4 years’ follow-up. A total of 355 eyes from 355 patients have been treated with Ru-106 plaque brachytherapy for uveal melanoma between February 2011 and March 2020. Five patients were lost to follow-up, and then 350 eyes of 350 patients (mean age 58 ± 11 years) were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination including echography and spectral domain–optical coherence tomography. The mean follow-up was 4 years (3 months to 9 years). After treatment, the mean tumor thickness was reduced to 1.75 ± 0.21 mm. Radiation complications were found in 63% of patients: 38% showed radiation maculopathy, 11% had optic neuropathy, and 14% developed cataracts. Cancer-free survival was 99%, 97%, and 85%, respectively, at 5, 7, and 9 years. Ru-106 plaque brachytherapy represents a reliable treatment of uveal melanoma. This technique is valid and safe with a low rate of ocular complications during a long-term follow-up.

Highlights

Radiation therapy is the main treatment approach for choroidal melanoma, and the most common irradiation techniques are plaque brachytherapy and proton therapy [5,6,7]. b-Ray source ruthenium-106 (Ru-106) is the most used in Europe [8]
Brachytherapy and proton beam radiotherapy are commonly applied in the treatment of uveal melanoma, and they represent
The efficacy of brachytherapy has been demonstrated in terms of patient survival, ocular preservation, control of the tumor, and distant metastasis [18, 19]

Summary

Introduction

Uveal melanoma is the most common primary intraocular malignancy, and it represents approximately 5% of all melanomas [1, 2].Enucleation of the affected eye was the only treatment in the past, but since 1970, the eyeconserving approach has been increasingly used until today [3] in order to preserve vision and the ocular anatomy without increasing the risk of metastatic spread [4].Uveal Melanoma and Brachytherapy: Long-Term OutcomesToday, radiation therapy is the main treatment approach for choroidal melanoma, and the most common irradiation techniques are plaque brachytherapy and proton therapy [5,6,7]. b-Ray source ruthenium-106 (Ru-106) is the most used in Europe [8].The Collaborative Ocular Melanoma Study (COMS) demonstrated equal melanoma-related survival rates for enucleation and episcleral plaque radiotherapy in mediumsized tumors (measuring 2.5 to 10 mm of apical height and 5 to 16 mm of basal dimension) [4]. Enucleation of the affected eye was the only treatment in the past, but since 1970, the eyeconserving approach has been increasingly used until today [3] in order to preserve vision and the ocular anatomy without increasing the risk of metastatic spread [4]. Radiation therapy is the main treatment approach for choroidal melanoma, and the most common irradiation techniques are plaque brachytherapy and proton therapy [5,6,7]. Plaque brachytherapy offers the patient a better quality of life with the possibility to preserve vision [4]. The aim of this retrospective study is to investigate the visual and anatomical outcomes, tumor control, tumor recurrence, distant metastasis, and cancer-free survival in patients undergoing Ru-106 plaque brachytherapy

Methods

Results

Conclusion