Eye Preservation Research Articles

Fractionated stereotactic radiotherapy for uveal melanoma, late clinical results

PurposeTo determine local control, late toxicity and metastatic free survival (MFS) of patients treated with fractionated stereotactic radiation therapy (fSRT) for uveal melanoma (UM). Methods and materialsBetween 1999 and 2007, 102 UM patients were included in a prospective study of a single institution (median follow-up (FU) 32months; median tumor thickness 6mm); five fractions of 10Gy were given. Primary endpoints were local tumor control and late toxicity (including visual outcome and eye preservation). Secondary endpoint was MFS. ResultsLocal tumor control was achieved in 96% of the patients. Fifteen enucleations were performed, 2–85months after radiation. Four eyes were enucleated because of local tumor progression. Nine patients developed grade 3 or 4 neovascular glaucoma (NVG), 19 developed severe retinopathy, 13 developed opticoneuropathy grade 3 or 4, 10 developed cataract grade 3, and 10 patients suffered from keratitis sicca. Best corrected visual acuity (BCVA) decreased from a mean of 0.26 at diagnosis to 0.16, 3months after radiation and it gradually declined to 0.03, 4years after therapy. The 5-year actuarial MFS was 75% (95% CIs: 62–84%). ConclusionsfSRT is an effective treatment modality for uveal melanoma with a good local control. With that, fSRT is a serious eye sparing treatment modality. However, our FU is relatively short. Also, the number of secondary enucleations is substantial, mainly caused by NVG.

Selective Ophthalmic Arterial Injection Therapy for Intraocular Retinoblastoma: The Long-Term Prognosis

To report the success rate, adverse events, and long-term prognosis of selective ophthalmic arterial injection (SOAI) therapy for intraocular retinoblastoma. Noncomparative case series. A total of 408 eyes of 343 patients. Retrospective chart review of patients with intraocular retinoblastoma treated with SOAI using a balloon catheter and melphalan between 1988 and 2007. The technical success rate of SOAI (we defined success as the successful injection of melphalan into the ophthalmic artery), ocular adverse events, systemic adverse events, secondary neoplasms, eye survival, and visual acuity. Selective ophthalmic arterial injection was successful in 1452 procedures of 1469 trials, and the success rate was 98.8%. Each eye received 1 to 18 rounds of SOAI. Two eyes (0.5%) developed severe orbital inflammation, and 2 eyes (0.5%) had diffuse chorioretinal atrophy. Transient periocular swelling or redness occurred in some cases. No severe systemic adverse events were detected. Transient bronchospasm occurred in 1 patient (0.3%), and transient vomiting occurred in several patients. Twelve secondary neoplasms occurred in 11 patients, and the cumulative incidence was 1.3% at 5 years, 4.8% at 10 years, and 5.8% at 15 years. The eye preservation rate was 100% in group A, 88% in group B, 65% in group C, 45% in group D, and 30% in group E according to the International Classification of Intraocular Retinoblastoma. Fifty-one percent of eyes had a visual acuity >0.5, and 36% of eyes had a visual acuity >1.0 at the last follow-up examination in cases without macular tumors. Selective ophthalmic arterial injection using a balloon catheter and melphalan achieved a success rate of 98.8% and was associated with few severe adverse events, including secondary neoplasms. More than half of the treated eyes were preserved, and more than half of the eyes without macular tumors maintained a visual acuity >0.5. Selective ophthalmic arterial injection is an established treatment method. We did not detect severe eye damage or severe systemic events; secondary neoplasms were seen but no more frequently than would otherwise have been expected. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Strategies to manage retinoblastoma in developing countries

Survival of retinoblastoma is >90% in developed countries but there are significant differences with developing countries in stage at presentation, available treatment options, family compliance, and survival. In low-income countries (LICs), children present with advanced disease, and the reasons are socioeconomic and cultural. In middle-income countries (MICs), survival rates are better (>70%), but there is a high prevalence of microscopically disseminated extraocular disease. Programs for eye preservation have been developed, but toxicity-related mortality is higher. Although effective treatment of microscopically extraocular disease improved the outcome, worldwide survival will be increased only by earlier diagnosis and better treatment adherence.

Local control and visual acuity following treatment of medium-sized ocular melanoma using a contact eye plaque: A single surgeon experience

Purpose To evaluate the outcomes of choroidal melanoma in (CM) patients treated with 125I episcleral plaque brachytherapy and to compare our single surgeon results with the multi-institutional Collaborative Ocular Melanoma Study (COMS). Methods and Materials A review was performed of all CM patients treated with 125I episcleral plaque brachytherapy by ophthalmologist in accordance with established COMS guidelines. Results The records of 35 patients were reviewed. The median longest basal tumor diameter and apical tumor height was 13.5 and 7.8 mm, respectively. Median dose to the apex was 8609 cGy at a median dose rate of 92 cGy/h. At a median followup of 45 months, 35 patients had local control and 33 had successful organ preservation. At 5 years, the local control rate was 100%, and the eye preservation rate was 94%. Five patients developed hepatic metastasis at a median of 58 months, and 2 succumbed from disease. The 5-year survival rate was 84%, and the 5-year rate of death with histopathologically confirmed metastasis was 15%. Of the 22 patients with at least 3 years of followup, 68% had a visual acuity in the treated eye of 20/200 or worse. Conclusion Excellent local control, eye preservation rates, and survival outcomes following 125I episcleral plaque application for CM can be optimized by having an experienced ophthalmologist place the plaques. Additionally, hepatic metastasis can occur more than 5 years postimplant regardless of local control; therefore, longer systemic staging should be considered.

Management of iris melanomas with 125 iodine plaque radiotherapy

Abstract Purpose The experience with 125Iodine (I125) plaque brachytherapy in the treatment of IM at the Princess Margaret Hospital/University Health Network is the subject of the report to follow. Methods All cases of IM submitted to I125 plaque radiotherapy were included. Patients' demographic, clinical, management, and follow‐up data were reviewed. Outcome measures included rates of tumor control, eye preservation, systemic metastases, and brachytherapy‐related complications. Results Fourteen IMs were included in the study. All patients had blue/green irises. Mean largest basal dimension and thickness were 7.1 +/‐ 2.1 mm (range, 4.0 to 11.5 mm) and 2.2 +/‐ 0.8 mm (range, 1.0 to 3.5 mm), respectively. Ten patients (71%) had seeding and 2 (14%) had glaucoma at presentation. Median follow‐up was 26.6 +/‐ 19.5 months (range, 6 to 72 months). Tumor control was achieved in 100% of the cases and no eye was enucleated because of radiation‐induced complications. At last visit, all patients were alive and free of metastasis. Final visual acuity was the same as or better than before treatment in 9 patients (75%). Cataract was the most common complication (8; 75%), followed by persistent glaucoma (2; 17%) and anterior uveitis (1; 8%). No other significant complication was seen during the follow‐up period. Conclusion Plaque radiotherapy is a safe and effective conservative treatment option for IM, although cataract is a common, yet treatable, complication. This treatment scheme circumvents an intraocular procedure and may avoid the dissemination of malignant cells, and provides a margin of safety in the treatment of clinically undetectable disease.

The role of transpupillary thermotherapy in combined treatment of retinoblastoma

Abstract Purpose Retinoblastoma (RB) is one of the most serious ophthalmic pathology in childhood. Treatment options that provide eye preservation include chemotherapy, brachytherapy, external beam radiation, cryotherapy and laser treatment. The aim of our study is to evaluate efficiency of transpupillary thermotherapy (TTT) as a part of combined treatment of RB. Methods Our group consists of 30 RB patients (34 eyes). All patients received systemic chemotherapy (Carboplatin and Vincristine). Tumor thickness before TTT varied from 0.9 to 2.6 mm, tumor base diameter varied from 2 to 10 mm. Seven patients had monolateral RB, others had bilateral lesion. Five patients were treated with brachytherapy before TTT. TTT was performed using infrared diode laser Nidec DC 3300. Exposure time was 60 seconds. Width of laser beam was from 1000 to 2000 nm. TTT power setting varied from 600 to 900 mW. Eleven patients had TTT more then once. Follow‐up period after TTT was up to 24 months. Results Control examination after TTT showed good response to the treatment in 27 eyes (79.4%).After TTT we saw hyperpigmented scar on the eye fundus at the place of previous tumor location, on OCT it looked like hyper‐reflective stripe replacing all layers of a retina. Seven eyes (20.6%) were resistant to TTT, five of them were successfully treated by additional brachytherapy. Two eyes were enucleated because of uncontrolled tumor growth. Evaluation of metastatic disease in all patients revealed no signs of metastasis at the time of treatment or during follow‐up. Conclusion TTT can be used in combined treatment of RB for small multifocal lesions. The method is rather simple and uncomplicated. Patients treated with TTT have better visual prognosis in comparison with brachytherapy.

SU-GG-T-86: Retrospective Evaluation of Symmetrically Loaded COMS Plaques for Juxtapapillary Choroidal Melanoma Patients Using Plaque Simulator

Purpose/Objective(s): The purpose of this study is to retrospectively evaluate the dosimetric coverage of I-125 plaque brachytherapy (IBT) in treating Juxtapapillary Choroidal Melanoma (JCM) using the Plaque Simulator treatment planning system. Materials and Methods: Thirty cases of JCM patients with a medium-sized tumor were treated by COMS IBT loaded non-uniformly but with circular symmetry from 1997–2005. Median follow-up was 48 months. The tumor was 0.75–2.5 mm from the optic disc. The median tumor thickness was 4.3 mm and the median longest tumor diameter was 9.9 mm. An in-house treatment planning system had been used for actual treatments. The proximity of the tumor to the optic nerve did not allow the plaque to be centered over the tumor, so the tumor edge closest to the optic nerve did not receive the dose specified in the COMS study. We used the Plaque Simulator treatment planning system (BEBIG, Germany) for replanning and assessing dose coverage of the tumor for these patients. Results When all corrections for dose calculation in the Plaque Simulator were taken into account, mean dose to tumor edge nearest the optic nerve were significantly lower than COMS recommendations (62Gy vs. 69Gy, p<0.02). Meanwhile, 4-year tumor control and eye preservation rates were both 90%, respectively. Radiotherapy complications included cataract in 53%, neovascular glaucoma in 10%, retinopathy in 53%, and papillopathy in 33% of treated patients. These rates are comparable to COMS outcomes study for non- Juxtapapillary tumors. Conclusion Similar tumor control rates for juxtapapillary tumors and tumors where the plaque can be centred over the tumor might imply that tumor edges do not need as high a dose as the tumor apex.

Long-term outcomes of eye-conserving treatment with Ruthenium 106 brachytherapy for choroidal melanoma

Purpose To evaluate long-term outcomes of eye-conserving treatment using Ruthenium-106 plaque brachytherapy with or without transpupillary thermotherapy (TTT) for small to intermediate size choroidal melanomas. Methods Outcomes of 425 consecutive patients were analysed. The median basal tumour diameter was 10.9 mm (range 4.8–15.9 mm), and the median apical height 4.2 mm (range 1.2–9.3 mm). Brachytherapy doses ranged from 400 to 600 Gy with TTT (86%), or from 600 to 800 Gy without TTT (14%), specified at the scleral surface. Kaplan–Meier survival curves, log-rank tests and Cox regression analysis were used for analysis. Results Median follow-up was 50 months. Five-year actuarial local control was 96%. Five-year overall and metastases-free survival rates were 79.6% and 76.5%. Prognostic factors for metastasis-free survival were peripheral location ( p = 0.02) and smaller basal diameter ( p < 0.001). No dose effect relationships were found. Radiation side effects were frequent, with 2- and 5-year rates free of radiation complications of 60% and 35%. Five-year enucleation rate was 4.4% (10 for local recurrence, 7 for complications). Cosmetic and functional (visual acuity >0.10) eye preservation rates were 96% and 52% at 5 years. Conclusions Ruthenium-106 brachytherapy for choroidal melanoma provides excellent rates of local control and eye preservation.

Management of Iris Melanomas With 125Iodine Plaque Radiotherapy

To report the experience of the Princess Margaret Hospital/University Health Network with the treatment of iris melanoma (IM) with (125)Iodine plaque brachytherapy. Retrospective noncomparative case series. All cases of IM submitted to (125)Iodine plaque radiotherapy were included. Patients' demographic, clinical, management, and follow-up data were reviewed. Outcome measures included rates of tumor control, eye preservation, systemic metastases, and brachytherapy-related complications. Fourteen IMs were included in the study. All patients had blue/green irises. Mean largest basal dimension and thickness were 7.1 +/- 2.1 mm (range, 4.0 to 11.5 mm) and 2.2 +/- 0.8 mm (range, 1.0 to 3.5 mm), respectively. Ten patients (71%) had seeding and 2 (14%) had glaucoma at presentation. Median follow-up was 26.6 +/- 19.5 months (range, 6 to 72 months). Tumor control was achieved in 100% of the cases and no eye was enucleated because of radiation-induced complications. At last visit, all patients were alive and free of metastasis. Final visual acuity was the same as or better than before treatment in 9 patients (75%). Cataract was the most common complication (8; 75%), followed by persistent glaucoma (2; 17%) and anterior uveitis (1; 8%). No other significant complication was seen during the follow-up period. Plaque radiotherapy is a safe and effective conservative treatment option for IM, although cataract is a common, yet treatable, complication. This treatment scheme circumvents an intraocular procedure and may avoid the dissemination of malignant cells, and provides a margin of safety in the treatment of clinically undetectable disease.

Management of ciliary body melanoma with iodine-125 plaque brachytherapy

Objective: Because ciliary body melanoma often defies early diagnosis, and its treatment is controversial, we report our experience with the clinical presentation and management of ciliary body melanoma, treated with iodine-125 plaque brachytherapy. Study Design: A retrospective noncomparative case series. Participants: Forty-two patients with ciliary body melanoma treated with iodine-125 brachytherapy. Methods: Electronic chart review of ciliary body melanoma patients treated at Princess Margaret Hospital, University of Toronto, Toronto, Ont. Patients' demographics and clinical, management, and follow-up data, including brachytherapy-related complications, were reviewed. Outcome measures included rates of tumour control, eye preservation, systemic metastases, and brachytherapy-related complications. Results: Median age at diagnosis was 58 years and median follow-up was 43 months. Ciliary body melanoma was asymptomatic in 55% of patients, whereas floaters or flashes were the main symptom in 33%. Median tumour thickness before brachytherapy was 5.2 mm and after brachytherapy was 3.3 mm. Radiation-induced cataract was the main complication in 55% of patients, radiation retinopathy in 24%, and neovascular glaucoma in 15%, which was controlled by topical treatment in half of the cases. Two patients developed metastases and 3 required secondary enucleation. Conclusions: Medium-sized ciliary body melanoma produced no or minimal symptoms on presentation in 88% of the patients. Iodine-125 plaque brachytherapy offered 98% tumour control at 43 months' follow-up. Radiation-related complications are generally manageable in most patients, which permits retention of the treated eye.

Salvage external beam radiotherapy after failed primary chemotherapy for bilateral retinoblastoma: rate of eye and vision preservation

Background:Radiation is implicated in the induction of second malignancies in children with bilateral retinoblastoma. There is a need to determine whether this risk can be justified by good visual outcome...

Iodine ‐125 episcleral brachytherapy for uveal melanoma : 133 cases

Abstract Purpose To assess the results of I125 Episcleral Brachytherapy (EB) in uveal melanoma: tumor control, visual acuity, eye preservation and survival Methods Prospective and consecutive study of patients with the diagnosis of uveal melanoma at the ocular oncology unit in the Valladolid University Hospital treated with EB between september 1997 and june 2008. Ocular examination, extraocular and systemic extension data have been registered in a database at the time of the diagnosis and during the follow up. Results Among a total of 310 patients diagnosed between September 1997 and June 2008, 133 were treated with EB with a mean age of 58.6 years. Mean follow up was 45.4 months. The onset was symptomatic in 78.2% and 66.9% were nodular and 30.1% mushroom shape. Regarding the size 80.5% were medium, 7.5 % small and 12% large. The median tumor height were 5.7 mm and median basal diameter 12 mm. The median dose to tumor apex delivered 89.6 Gy. After 4.9 year of follow up tumor were controlled in 99% with a 57.9% reduction in the mean height; only two patients showed recurrence; 64.1.% maintain visual acuity &gt; 0.1 and 33.3% &gt; 0.5 with . Only 7 patients underwent enucleation due to complications and there are 1 death related to melanoma up to date. Conclusion I125 Episcleral Brachytherapy is effective regarding tumour control, allowing preservation of the eye and useful visual function for the majority of patients with uveal melanoma.

Sparing the Eye in Craniofacial Surgery for Superior Nasal Vault Malignant Neoplasms

To evaluate orbital and ophthalmologic function following standardized eye-sparing protocol for treating superior nasal vault malignant neoplasms. A retrospective review of patients with sinonasal malignant neoplasms who underwent preoperative radiation therapy with or without chemotherapy and craniofacial resection (CFR) with eye preservation. Pretreatment and posttreatment ophthalmologic evaluations were performed. A total of 59 patients underwent eye-sparing therapy between 1983 and 2005; 36 had invasion of the lamina with or without periorbital resection (61%). The most common abnormality was esthesioneuroblastoma (37 cases; 63%), most of which were Kadish stage C (n = 26). The most common preoperative ophthalmologic findings were motility disturbances (18 cases; 31%), afferent pupillary dysfunction and change in acuity (17 cases; 29%), and proptosis (17 cases; 29%). A total of 36 patients were available for long-term follow-up (mean follow-up, 61 months); 35 of these retained functional vision (97%); and 1 patient had a nonfunctional eye. Standardized treatment for superior nasal vault malignant neoplasms using an eye-sparing CFR remains a sound approach both oncologically and ophthalmologically. Most patients with advanced disease present with ophthalmologic findings, and most posttreatment eye findings are notable only on detailed examination and either resolve spontaneously in the acute-care setting or do not require surgical repair.

Management of eye in maxillary tumours

Aim: Criteria to decide preserving the orbit in Maxillary Sinus Surgeries. Methods: A retrospective analysis of malignancy of Maxillary Sinus in the last 5 years was analysed. All histologies were included and adjuvant treatment was decided based on the histology, stage and extent of orbital involvement. Results: It was found that the orbit could be preserved in so far as the orbital periosteum was found intact in tumours of squamous cell nature and previous chemo-radiation enhances the possibility of eye preservation.

Treatment of retinoblastoma: Current status and future perspectives

Treatment of retinoblastoma must be individualized. Most patients with unilateral, non-metastatic retinoblastoma can be cured with enucleation alone. In patients with histologic risk factors, adjuvant chemotherapy is recommended, with the addition of orbital radiation for patients with trans-scleral involvement or tumor present at the level of the cut end of the optic nerve. Patients with metastases require intensive chemotherapy and consolidation with autologous hematopoietic stem cell rescue. Patients with bilateral or multifocal disease represent a major challenge. Cure of the disease is the first priority, but the therapeutic approach also has to consider eye and vision preservation. The approach is conservative, and only eyes with very advanced disease are enucleated upfront. Patients are treated with chemotherapy and intensive focal treatments, with the aim of delaying or avoiding radiation therapy and enucleation. For patients with early intraocular stage (Reese-Ellsworth groups I-III and International Groups A-B), the two-drug combination of vincristine and carboplatin is recommended. Patients with more advanced intraocular disease (Reese-Ellsworth groups IV-V and International Groups C-D) require more intensive chemotherapy. Standard of care for these patients incorporates etoposide into the regimen. Effective agents with good intraocular penetration, such as topotecan, are being investigated. Because most failures are secondary to progression of the vitreous seeds, subconjunctival carboplatin is added in cases with poor response of the vitreous tumors. Patients must be monitored very closely, with examinations under anesthesia every 4 to 6 weeks, and focal treatments are applied during the procedure. These include cryotherapy for small anterior tumors, thermotherapy and laser photocoagulation for small posterior tumors, and brachytherapy for larger tumors. New treatment approaches under development include the refinement of periocular chemotherapy administration using slow-release devices, the use of suicide gene therapy with local delivery of the herpes simplex thyrosine kinase gene (followed by systemic administration of ganciclovir), and the development of small-molecule inhibitors of the MDMX-p53 interaction.

Proton beam therapy for iris melanomas

To describe the results in terms of local control, eye preservation and systemic evolution of iris melanomas treated by proton beam irradiation. Retrospective review of the charts of patients with iris melanoma treated by proton beam therapy between April 1998 and September 2002. Ciliary body melanomas with iris involvement or tumours with extrascleral invasion were excluded. Treatment consisted of 60 Gy of proton beam irradiation delivered in four fractions to the tumour volume. A total of 21 patients were treated, median follow-up of 33 months (8-72 months). 15 patients presented a lesion with documented growth. The median clinical diameter was 5 mm (2-8 mm), the median ultrasound diameter 4.8 mm (2-7.7 mm) The patients were 6% T1, 57.1% T2, and 14.3% T3 all N0M0. The iridocorneal angle was invaded by the tumour in 71.4% of patients. At the end of follow-up, all patients were alive with no proven metastatic disease except one patient with suspicious liver lesions. None of the patients showed tumour progression or ocular relapse. The tumour response at 2 years was a flat lesion for 6.3% of cases, partial regression in 75% and stable in 18.8%. None of the patients required secondary enucleation. The main complication was cataract (45% within 24 months of treatment). Raised intraocular pressure was observed in 15% of patients but no neovascular glaucoma. Proton beam therapy shows potential utility for selected cases of localised iris melanomas allowing excellent local tumour control and eye preservation. Further follow-up on larger series is needed to confirm these results.

β-Ray brachytherapy with 106Ru plaques for retinoblastoma

A retrospective analysis of 134 patients who received (106)Ru brachytherapy for retinoblastomas (175 tumors in 140 eyes). Treatment and follow-up were analyzed with special emphasis on tumor control organ, preservation, and late complications. Treated tumors had a mean height and diameter of 3.7+/-1.4 mm and 5.0+/-2.8 disk diameters, respectively. The radiation dose values were recalculated according to the calibration standard recently introduced by the National Institute of Standards and Technology. The recalculation revealed a mean applied dose of 419 Gy at the sclera (SD, 207 Gy) and 138 Gy (SD, 67 Gy) at the tumor apex. The 5-year tumor control rate was 94.4%. Tumor recurrence was more frequent in eyes with vitreous tumor cell seeding or fish-flesh regression. The estimated 5-year eye preservation rate was 86.5%. Previous treatment by brachytherapy or external beam radiotherapy, as well as a large tumor diameter, were significant factors for enucleation. The radiotherapy-induced complications after 5 years of follow-up were retinopathy (22%), optic neuropathy (21%), and cataract (17%). These complications were significantly more frequent after prior brachytherapy or external beam radiotherapy. Brachytherapy using (106)Ru plaques is a highly efficient therapy with excellent local tumor control and an acceptable incidence of side effects.

DE NOVO INTRAOCULAR RETINOBLASTOMA DEVELOPMENT AFTER CHEMOTHERAPY IN PATIENTS WITH HEREDITARY RETINOBLASTOMA

Identification of incidence and risk factors for recurrence of de novo retinoblastomas after chemotherapy treatment in patients with hereditary retinoblastoma. A retrospective, case-control study of 32 patients (50 eyes) with sporadic or familial bilateral retinoblastomas was conducted. Patients received a systemic chemotherapy regimen applying three courses of a combination of three drugs (including vincristine, etoposide, carboplatin, or cyclophosphamide) followed by additional local therapy. The primary outcome analyzed was the development of retinoblastomas, probably arising as the cause of a new mutational event (de novo) after completion of chemotherapy treatment. Patients were treated with an average of 5.8 +/- 1.8 chemotherapy courses (4.6 +/- 2.4-year follow-up time). Development of de novo tumors occurred in 48% of the treated eyes. These tumors occurred during chemotherapy treatment or within 7 months of chemotherapy completion. No de novo tumors developed in patients older than 3.2 years. Children who developed de novo tumors were significantly younger at the time of diagnosis (6.7 +/- 6.3 months vs 14.4 +/- 11.4 months, P < 0.001), and had a significantly lower number of tumors per eye at treatment begin (2.6 +/- 2.3 tumors vs 4.3 +/- 6.4 tumors, P < 0.001). The difference of the total numbers of retinoblastomas that developed per eye between the patients that developed de novo retinoblastomas during or after chemotherapy and patients who did not was not statistically significant (4.9 +/- 2.7 and 4.3 +/- 6.4, respectively, P = 0.8). No eye was lost because of de novo retinoblastoma development, and 92% of the eyes were preserved. De novo retinoblastomas developed both during and after completion of chemotherapy treatment. Younger children were at a significantly higher risk for developing de novo intraocular retinoblastomas. Good tumor control and eye preservation rates were achieved with regular and frequent control examinations in addition to the immediate treatment of de novo retinoblastomas.

Visual outcome, local tumour control, and eye preservation after 106Ru/Rh brachytherapy for choroidal melanoma

To study the visual outcome, local tumour control, and eye preservation 5 years after ruthenium/rhodium 106 brachytherapy for choroidal melanoma. The study included 55 consecutive patients treated by 106Ru/Rh brachytherapy for a choroidal melanoma during the period 1988–2000 and followed through 2004. The 5-year probability for not losing at least 5 Snellen lines was 59% (n = 45), for retaining a visual acuity of 0.33 or better was 28% (n = 34), and for retaining better than 0.1 was 40% (n = 45). The 5-year probability for no local recurrence was 73% and for eye preservation 72% (n = 55). 106Ru/Rh brachytherapy for choroidal melanoma resulted in a clinically significant vision loss, no local recurrence, and eye preservation in most patients after 5 years. 106Ru/Rh brachytherapy can be regarded as a good treatment option for small and medium-sized tumours but not for large tumours.

Visual Outcomes and Eye Preservation After Iodine-125 Brachytherapy for Uveal Melanoma

Visual Outcomes and Eye Preservation After Iodine-125 Brachytherapy for Uveal Melanoma