Abstract
Purpose. To evaluate our community-based institutional experience with plaque brachytherapy for uveal melanomas with a focus on local control rates, factors impacting disease progression, and dosimetric parameters impacting treatment toxicity. Methods and Materials. Our institution was retrospectively reviewed from 1996 to 2011; all patients who underwent plaque brachytherapy for uveal melanoma were included. Follow-up data were collected regarding local control, distant metastases, and side effects from treatment. Analysis was performed on factors impacting treatment outcomes and treatment toxicity. Results. A total of 107 patients underwent plaque brachytherapy, of which 88 had follow-up data available. Local control at 10 years was 94%. Freedom from progression (FFP) and overall survival at 10 years were 83% and 79%, respectively. On univariate analysis, there were no tumor or dosimetric treatment characteristics that were found to have a prognostic impact on FFP. Brachytherapy treatment was well tolerated, with clinically useful vision (>20/200) maintained in 64% of patients. Statistically significant dosimetric relationships were established with cataract, glaucoma, and retinopathy development (greatest P = 0.05). Conclusions. Treatment with plaque brachytherapy demonstrates excellent outcomes in a community-based setting. It is well tolerated and should remain a standard of care for COMS medium sized tumors.
Highlights
Uveal melanoma is an uncommon cancer, with age-adjusted incidence rates of 4.3 new cases per million [1]
Plaque brachytherapy has been utilized for uveal melanomas at our institution since 1996 and has been performed in a community-based setting
Tumor characteristics were classified according to the COMS classification, with medium sized tumors having a height of 2.5–10 mm and diameter of 5–16 mm, large tumors a height of >10 mm or diameter >16 mm, and small tumors heights of
Summary
Uveal melanoma is an uncommon cancer, with age-adjusted incidence rates of 4.3 new cases per million [1]. There have been multiple investigations into appropriate treatment options, and current accepted standards range from observation to enucleation, all dependent on the size and characteristics of the tumor [3,4,5]. Brachytherapy is frequently utilized for medium sized tumors (apical height 3–10 mm and basal diameter 5–16 mm) and has been shown to be equivalent to enucleation for tumors in this category [3]. Treatment delivery is quite complex, and it has been recommended to only undertake this treatment approach at medical centers with the appropriate expertise [6]. Recommendations have been made by the American Brachytherapy Society regarding appropriate treatment delivery and planning [6]
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