Ruthenium‐ 106 brachytherapy in the treatment of central choroidal melanoma

Abstract

Aims/Purpose: Choroidal melanoma is the most common ocular malignancy. Depending on the size of the tumour and its location in relation different treatment options are available. Brachytherapy with β‐emitting Ruthenium‐ 106 plaque is an effective and widely used treatment. The treatment of juxtapapillary and juxtafoveolar choroidal melanoma is challenging because it involves the macula and optic nerve. Studies have shown that central choroidal melanomas have a high recurrence rate.Methods: A total of 56 eyes of 56 patients with central choroidal melanoma were included in this retrospective study and treated with Ru‐106 brachytherapy between January 2011 and July 2020 in our institution. As central choroidal melanomas were defined all juxtafoveolar melanomas with a posterior edge touching an optic disc‐ fovea‐ radius around the fovea (about 5 mm). We measured visual acuity, recurrence, radiation related side effects and metastasis. The mean follow‐ up time was 66 (6–136) months.Results: Of the 56 eyes, 8 eyes (14%) showed a recurrence during the follow‐ up period. It was shown that the choroidal melanomas closer to the optic disc have a higher recurrence rate than the once close to the macula (69% vs. 95%). A radiation retinopathy was detected in 7 eyes (13%), a radiation opticopathy in 7 eyes (13%) and a radiation maculopathy in 10 eyes (17.9%). 6 eyes (11%) had to be enucleated because of recurrence or radiation complication.Conclusions: Ruthenium brachytherapy is an effective therapy for central choroidal melanoma with a rate of preserving the eye of 89%. The localization of the choroidal melanoma near the optic disc goes ahead with a higher rate of complications and recurrences.