Radioactive Plaque Research Articles

A novel 3D printing method for a notched eye plaque “dummy” for uveal melanoma brachytherapy

PurposeSuture pre-placement by the ocular oncology surgeon is a critical step before inserting a radioactive plaque for ocular melanoma brachytherapy. We report on a novel 3D-printing method to create a custom “dummy” plaque applicator for the 22 mm notched gold plaque using in-house 3D-printing. MethodsA computer-aided design (CAD) file was created replicating a heavily used gold plaque that no longer has a satisfactory “dummy” plaque. The file was exported as a 3D file (surface tessellation language, STL) and prepared using Formlabs’ PreForm print software. The 3D-printed dummies were oriented on the printer to have no cups or supports on the surfaces that would come in contact with the patient's external sclera. The dummies were printed in FormLabs BioMed Clear V1 on a Formlabs Form-3 3D printer. Post-printing, the dummies were processed in isopropyl alcohol and cured according to manufacturer instructions. They were polished utilizing a rotary tool to improve transparency. Chemical and sterilization cycle tests were performed to ensure dummy integrity. ResultsFour “dummy” plaques were printed. The 3D-printed “dummy” dimensions were verified to be within 0.5-mm of the notched plaque using digital calipers. The polishing process created acceptable light opacity for the eye plaque procedure in the operating room. No impactful discoloration or material change was observed during the chemical and sterilization cycle tests performed. Conclusions3D printing can produce custom eye plaque dummies using transparent, biocompatible, chemically inert materials suitable for human use. This capability introduces an additional layer of patient-specific hygienics.

Disinsert, retract and rotate technique of plaque brachytherapy.

Plaque brachytherapy is commonly used in the management of choroidal melanomas. The surgical steps usually involve creating a conjunctival peritomy, fixing the recti muscles, with or without disinserting them based on the location of the lesion, and placing the plaque. The inferior oblique muscle is attached close to the macula, and in cases of perimacular or peripapillary lesions, the muscle needs to be sacrificed. The authors here demonstrate a novel technique of placing radioactive plaque without disinserting the inferior oblique muscle in cases of perimacular or peripapillary choroidal melanomas. The video demonstrates how the "disinsert, retract, and rotate technique" of brachytherapy plaque placement can be performed and what are the fundamentals behind this technique. The authors have performed this procedure multiple times and there has been no incidence of plaque tilt or migration. In perimacular and peripapillary choroidal melanoma brachytherapy plaque placement, the inferior oblique muscle can be spared. The simple technique does not lead to any tilt or migration of the radioactive plaque. https://youtu.be/YMIg3rYyp2o.

B-scan measurements of intraocular tumor heights intraoperatively, before and after radioactive plaque application: A comparative prospective study

To assess the difference in intraocular tumors height measurements intraoperatively before and after radioactive plaque application. Twenty-four eyes of 24 patients with intraocular tumors, candidates for radioactive therapy, were included. Each tumor was measured at the same setting before and after plaque application independently by 3 sonographers, using a 20-MHz B-scan transducer. Mean pre-plaque and post-plaque measurements were calculated and recorded. An A-scan vector aided in identification of the inner and outer tumor surfaces. Each patient was examined independently three times by three experienced ultrasonographers within the same setting to assess interobserver variability. There was no statistically significant difference between the 3 examiners' readings, with P-value 0.99 for pre-plaque height and 0.97 for post-plaque height. Mean pre-plaque height was 5.16±2.11mm, while post-plaque height was 5.51±2.1mm (P-value 0.001). The Spearman correlation test showed that initial tumor height was negatively correlated with the difference between both heights, but with no statistical significance. Intraocular tumor height measurement differs significantly before and after plaque application. Use of the pre-plaque height is advised until further studies are performed to assess the effect of this difference on treatment outcomes.

Tumor Shape-Specific Brachytherapy Implants by 3D-Printing, Precision Radioactivity Painting, and Biomedical Imaging.

In brachytherapy (BT), or internal radiation therapy, cancer is treated by radioactive implants. For instance, episcleral plaques (EPs) for the treatment of uveal melanoma, are designed according to generic population approximations. However, more personalized implants can enhance treatment precision through better adjustment of dose profiles to the contours of cancerous tissues. An original approach integrating biomedical imaging, 3D printing, radioactivity painting, and biomedical imaging, is developed as a workflow for the development of tumor shape-specific BT implants. First, computer-aided design plans of EP are prepared according to guidelines prescribed by the Collaborative Ocular Melanoma Study protocol. Polyetheretherketone (PEEK), a high-performance polymer suitable for permanent implants, is used to 3D-print plaques and the geometrical accuracy of the printed design is evaluated by imaging. The possibility to modulate the dose distribution in a tridimensional manner is demonstrated by painting the inner surfaces of the EPs with radioactive 103Pd, followed by dose profile measurements. The possibility to modulate dose distributions generated by these 3D-printed plaques through radioactivity painting is therefore confirmed. Ex vivo surgical tests on human eyeballs are performed as an assessment of manipulation ease. Overall, this work provides a solution for the fabrication of tumor-specific radioactive implants requiring higher dose precision.

Dosimetric Investigation of Six Ru-106 Eye Plaques by EBT3 Radiochromic Films and Monte Carlo Simulation.

Ophthalmic brachytherapy using radioactive plaques is an effective technique for the treatment of uveal melanoma. Ru-106 eye plaques are considered as interesting issue due to their steep gradient dose. The pre-planning evaluation of dosimetric parameters is essential for the treatment planning system. The current study aims at providing dose distributions of six Ru-106 eye plaques (CCA, CCB, CGD, CIB, COB and COD) using radiochromic EBT3 film, Geant4 Monte Carlo toolkit and the treatment planning software (Plaque Simulator). In this experimental study, an in-house phantom was employed for depth dose measurements with EBT3 films. Also, Geant4.10.5 scoring mesh was implemented to obtain the 2D dose distribution of the plaques. The results were compared with Plaque Simulator software and the manufacturer's (BEBIG) data. The gamma index criterion (3%/3 mm) was used to evaluate dose distributions obtained by the film measurements and Geant4 simulation. A good agreement was achieved between simulation and experimental results. Gamma index passing rate was 94.2%, 89.3%, 88.2%, 82.2%, 92.2% and 90.1% for CCA, CCB, CGD, CIB, COB and COD plaques, respectively. Absolute dose rate (mGy/min) obtained by EBT3 film at the depth of 2 mm was 79.4 mGy/min, 81.0 mGy/min, 78.6 mGy/min, 62.2 mGy/min, 75.2 mGy/min and 81.2 mGy/min for CCA, CCB, CGD, CIB, COB and COD plaques, respectively. The measured dose distributions and lateral dose profiles may be utilized in the treatment planning system to cover clinical volumes such as the clinical target volume and the gross tumor volume.

Iodine-125 plaque brachytherapy for diffuse choroidal hemangioma.

To report 6 cases of diffuse choroidal hemangioma (DCH) in children treated with iodine-125 plaque brachytherapy at a single tertiary care center. Retrospective case series. Six pediatric patients diagnosed with DCH were included in the study. Pre-plaque visual acuity (VA) ranged from 20/150 to no light perception (NLP). All patients had extensive serous retinal detachment at presentation. An iodine-125 radioactive plaque was placed on the affected eye to administer a dose of 34.2-42.1 Gy to the tumor apex over a median of 4 days. Tumor regression and subretinal fluid resolution were observed in all eyes within 17 months of treatment. Visual acuity improved in 2 patients. Radiation-induced cataract and subretinal fibrosis were documented in 1 case, and 1 patient developed radiation retinopathy. No patients developed neovascular glaucoma within a follow-up range of 12-65 months. Iodine-125 plaque radiotherapy is an effective option for DCH, although there is a risk for radiation-induced complications.

RSC: A 3D printed eyeball phantom for Sr-90 dosimetry measurements

Strontium 90 (Sr-90) has been commonly used in the radiation treatment of pterygia of the eye. A radioactive plaque is placed in an applicator onto the surface of the eyeball for a specific length of time to achieve a desired dose. Dose is usually calculated using source activity and decay, as well as the distance from it to the surface of the eye. However, this assumes a flat eye surface. This investigation used 3D printing to produce an anthropomorphic eyeball phantom on which to perform dosimetry measurements for two different applicator sizes. These doses were compared to planar geometry measurements and a dose difference found. While planar geometry measurements are useful for routine quality assurance, measurements of the effects of the curved surface on dose calculations can provide valuable clinical information.

Episcleral Iodine-125 radioactive plaque brachytherapy as a salvage treatment for retinoblastoma in the era of intraarterial chemotherapy.

Retinoblastoma shows high rates of recurrence after initial chemotherapy (systemic or intraarterial). Our aim was to evaluate the effectiveness of iodine-125 radioactive plaque brachytherapy as a salvage treatment with globe-preserving attributes after initial chemotherapy in patients with intraocular retinoblastoma. The effect of brachytherapy was investigated retrospectively in 17 eyes of 17 patients who were followed up due to retinoblastoma between May 2012 and June 2018 and who received iodine-125 radioactive plaque brachytherapy as a salvage treatment after systemic or intra-arterial chemotherapy. The regression, ocular toxicity, and enucleation rates were evaluated at the end of the follow-up period. The tumor locations were post equator, macular, anterior to the equator, and peripapillary in 5, 3, 7, and 2 patients, respectively. Regression was initially and rapidly observed in 17 of the 17 eyes that underwent brachytherapy. Enucleation was performed in 5 (29.42%) of these patients due to recurrence with diffuse tumor involvement, and 4 of the tumors were located anterior to the equator. In 12 (70.58%) patients, the eyes were protected from enucleation following local brachytherapy. Radioactive plaque brachytherapy can be applied as an effective salvage therapy with successful results in retinoblastoma patients who have received initial systemic or intra-arterial chemotherapy. Post equator-located solitary tumors have the highest success rate.

OC-0530 Local TCP and NTCP after radioactive plaque therapy for uveal melanoma: a data pooled analysis

OC-0530 Local TCP and NTCP after radioactive plaque therapy for uveal melanoma: a data pooled analysis

Outpatient ocular brachytherapy: The USC Experience

PurposeOcular brachytherapy is a standard-of-care surgical procedure for globe salvage in the treatment of uveal melanoma. The procedure involves the placement and subsequent removal of a radioactive plaque several days later. At many locations, patients are admitted on an inpatient basis until plaque removal due to radiation safety concerns. However, patients may be discharged to home after plaque insertion, and subsequently return to the medical facility for plaque removal. This study aimed to evaluate the safety and systematic financial benefit of the outpatient ocular brachytherapy program at "?>the University of Southern California (USC) Roski Eye Institute for 30 years. Methods and MaterialsA single-institution retrospective record review was performed on all 275 patients who underwent brachytherapy for ocular tumors between January 1, 1989 and December 31, 2019 to assess for occurrences of reportable radiation and/or patients safety events. The treatment protocols at our institution are described. Data on hospital-adjusted expenses per inpatient day from the American Hospital Association's 2018 Annual Survey were used as a proxy for costs to patients and the health care system to perform a cost–benefit analysis comparing outpatient versus inpatient brachytherapy. ResultsOf the 275 plaque procedures over a 30-year period that were reviewed, there were no internally or externally reportable patient or radiation safety events. There were no adverse events related to patient transportation to the hospital, the patient not returning for plaque removal, operative issues in removing the plaque on time due to cancelled or delayed cases, or loss of radioactive material. Additionally, our cost–benefit analysis estimates that outpatient brachytherapy reduced costs for USC’s patients in 2018 by an average of $24,722 per patient treated with ocular brachytherapy. ConclusionsWith appropriate measures, outpatient ocular brachytherapy allows patients to safely return home with the added benefit of decreased financial burden for both patients and the broader health care system.

MRI and dual-energy CT fusion anatomic imaging in Ru-106 ophthalmic brachytherapy

PurposeBrachytherapy with Ru-106 is widely used for the treatment of intraocular tumors, and its efficacy depends on the accuracy of radioactive plaque placement. Ru-106 plaques are MRI incompatible and create severe metal artifacts on conventional CT scans. Dual-energy CT scans (DECT) may be used to suppress such artifacts. This study examines the possibility of creating fusion images from MRI scans (preoperatively) and DECT scans (with the plaque in place) as a tool for confirming the anatomic accuracy of plaque placement. Methods and MaterialsSix patients with intraocular lesions (5 with choroidal melanoma and 1 with a retinal vasoproliferative lesion) were included. Fusion images of preoperative MRI scans and DECT scans with the plaque in place were created with the Demo version of the ImFusion suite (ImFusion GmbH, Munchen Germany). Clearance margins between the tumor and plaque edge in axial, transverse, and coronal planes as well as the elevation of the posterior plaque edge from the sclera were recorded and associated with the location of the lesion. ResultsPlaque-tumor clearance margins for transverse, sagittal, and coronal planes were higher for anteriorly located lesions (5.13 mm ± 0.11 [5.0–5.2], 5.10 mm ± 0.26 [4.9–5.4], and 5.33 mm ± 0.45 [4.9–5.8] respectively) than for posteriorly located lesions (4.16 mm ± 1.44 [2.5–5.1], 4.13 mm ± 1.42 [2.5–5.1], and 4.2 mm ± 1.21 [2.8–5.0], respectively). The elevation of the posterior plaque edge from the sclera was 0.33 mm ± 0.28 [0–0.5] and 0.63 mm ± 0.60 [0.7–1.2] for posterior and anterior lesions, respectively. ConclusionsFusion images between DECT and MRI scans may be used as a tool to confirm the accuracy of Ru-106 plaque placement in relation with the intraocular tumors in ophthalmic brachytherapy.

Intra-operative ocular ultrasonography of iodine-125 brachytherapy plaques in patients with uveal melanoma.

PurposeBrachytherapy with iodine-125 (125I) has been extensively used as a conservative treatment for uveal melanoma (UM). Surgical technique for correct placement of episcleral radioactive plaques (ERP) in UM cases with posterior choroidal location and/or small size can be difficult and inaccurate. In this study, the correct positioning of plaques was assessed by intra-operative ultrasound control.Material and methodsThis was a longitudinal, retrospective study of consecutive 20 patients with UM (small-medium size and/or posterior location) who received 125I brachytherapy. Location of plaques was adjusted by intra-operative ocular ultrasonography control. To perform ocular intra-operative ultrasonography, a 10 MHz probe was used to longitudinal and transverse bases in corresponding dummy plaques.ResultsThe study included 8 males and 12 females, with a mean age of 66.3 years (SD = 14.53), 5 right eyes (RE) and 15 left eyes (LE). In ultrasound examination, 4 UMs were of mushroom morphology and the rest nodular. Means of the size of UM by ultrasound were (mm): Lb: 10.60 (SD = 2.24) × Tb: 9.88 (SD = 1.54) × H: 4.02 (SD = 1.44) (3 cases corresponding to small size of collaborative ocular melanoma study (COMS), and 17 cases to medium). The plaques used were between 14 and 20 mm in diameter, with an average distance between the edge of greater base of the tumor and the edge of plate of 2.44 mm (SD = 0.34). It was necessary to surgically reposition the plaque in 4 cases (20%).ConclusionsIntra-operative ultrasound control improves the accuracy of radioactive plaque placement for the treatment of medium-small UMs in posterior location. Probably, this technique should be applied in all cases of brachytherapy, regardless of the isotope chosen and the location of tumor mass, in order to perfectly adjust therapeutic position.

Multiple Uveal Melanoma

Introduction: Multiple uveal melanoma is a rare occurrence and includes bilateral melanoma, unilateral multiple/multifocal melanoma, or melanoma with metastasis to the ipsilateral or contralateral eye. Methods: A chart review of patients diagnosed with uveal melanoma between January 2013 and January 2019 at the Duke University Eye Center Ophthalmic Oncology Service was performed. Results: Three patients with multiple, sequential melanoma were identified; patient 1 had bilateral choroidal melanoma and patients 2 and 3 had 2 choroidal melanomas occurring in the same eye. In all 3 patients, both the first and sequential choroidal melanomas were treated with I-125 radioactive plaque brachytherapy (PBT). Two patients were found to have developed secondary metastatic uveal melanoma as a presenting sign of systemic metastases. Patient 4, initially treated with PBT, was diagnosed with ipsilateral metastatic choroidal melanoma, also treated with PBT. Patient 5 had right eye enucleation for choroidal melanoma and developed vision-threatening metastasis in the left eye, which was treated with PBRT. None of the patients had history of cancer prior to their first diagnosis. Patients 1 and 5 were tested with a systemic melanoma panel; both were negative for BAP1, but patient 1 had a variant of unknown significance in BRCA2. Patient 3 had oculodermal melanocytosis, an established risk factor of uveal melanoma. Conclusion: Although rare, the possibility of multiple uveal melanoma does exist. Examination of the treated and contralateral eye on a regular basis is crucial, not only to identify local failure but also new metastases from the primary tumor and additional primary tumors.

Cherenkov Luminescence Imaging for Assessment of Radioactive Plaque Position in Brachytherapy of Uveal Melanoma: An In Vivo Feasibility Study.

PurposeTo study the feasibility of using Cherenkov luminescence imaging (CLI) to evaluate and document ruthenium-106 plaque position during brachytherapy of uveal melanoma.MethodsRuthenium-106 decays by emitting high-energy beta particles. When the electrons pass through the eye, Cherenkov radiation generates a faint light that can be captured by highly sensitive cameras. Patients undergoing ruthenium-106 plaque brachytherapy for posteriorly located choroidal melanoma were examined by CLI, which was performed in complete darkness with an electron multiplying charged-coupled device camera mounted on a fundus camera modified for long exposures.ResultsTen patients with tumors ranging from 5.8 to 13.0 mm in largest basal diameter and 2.0 to 4.6 mm in height were included. The plaques had an activity between 0.035 and 0.089 MBq/mm2 at the time of examination (1–4 days after implantation). CLI revealed the actual plaque position by displaying a circular area of light in the fundus corresponding with the plaque area. The Cherenkov light surrounded the tumor as a halo, which showed some asymmetry when the plaque was slightly displaced. The light intensity correlated positively with plaque activity and negatively with tumor pigmentation. Exposure times between 30 and 60 seconds were required to display the plaque position and delineate the tumor area. The long exposures made it difficult to maintain stable eye fixation and optimal image quality.ConclusionsCLI is a novel method to assess and document ruthenium-106 plaque position in brachytherapy for uveal melanoma.Translational RelevanceOcular CLI may provide relevant radiation data during and after implantation of radioactive plaques, thus improving the accuracy of episcleral brachytherapy.

The Role of Eye Plaque Brachytherapy and MR Imaging in the Management of Diffuse Choroidal Hemangioma: An Illustrative Case Report and Literature Review

Abstract Diffuse choroidal hemangioma (DCH) is a rare, benign vascular eye tumor that typically presents as part of Sturge-Weber syndrome. The tumor is clinically ill-defined with indistinct margins and blends subtly with the choroid. Associated exudative retinal detachment is a common complication that is reversible with management. External beam radiation therapy (EBRT) has traditionally been used for treatment. There have been limited reports on the use of radioactive eye plaque brachytherapy. A necessary component of eye plaque brachytherapy is accurate target delineation. Unfortunately, traditional computed tomography (CT) does not reveal the footprint of this vascular tumor, especially in the presence of retinal detachment. We report a case where magnetic resonance imaging (MRI) was used to aid in radiation target delineation for radioactive eye plaque brachytherapy. A thin-slice orbital MRI enhanced with gadolinium contrast was performed to differentiate the enhanced tumor from the unenhanced subretinal fluid, allowing for hemangioma delineation. Our patient was treated with 35Gy to the tumor apex over four days via radioactive iodine eye plaque. Subretinal fluid in the macula improved within a month and the exudative retinal detachment resolved within six months. There was no recurrence of subretinal fluid at three years. Our case illustrates radioactive iodine eye plaque brachytherapy is safe and effective for management of DCH-associated retinal detachment. MRI with contrast should be considered as an imaging modality to differentiate tumor from the surrounding subretinal fluid, allowing for improved delineation and targeted radiation.

Trends in Radiation Practices for Female Ocular Oncologists in North America: A Collaborative Study of the International Society of Ocular Oncology

Background: The aim of this study was to determine the known radiation exposure, attitudes, and consequent risk modifications among female ocular oncologists in North America who routinely administer radioactive plaque brachytherapy treatment and are members of the International Society of Ocular Oncology. Methods: Nineteen female ocular oncologists completed an anonymous 17-question radiation exposure survey. Results: Eleven of the participants chose to routinely wear lead protection during surgery; 8 did not. Fifteen of 19 participants reported using an unloaded “nonactive” template to prepare for plaque implantation. During pregnancy, 11 of 13 participants continued to perform plaque brachytherapy. Eight of these 11 undertook measures to decrease radiation exposure self-reported as lead wear and other. The average reported anxiety regarding fertility was 2.1 (SD, 2.2) on a scale from 1 to 10. Conclusion: This study corroborates prior literature that surgeons’ exposure to radiation during plaque brachytherapy is minimal. Nonetheless, there remains some anxiety regarding exposure risk to women, due to potential effects on fertility and fetal health. We found variability in exposure monitoring, required training, and precautions during pregnancy amongst this group of surgeons. Improved education and clearer pregnancy guidelines may equip female ocular oncologists with optimal knowledge regarding risk of radiation exposure.

Incidence and Management of Retinoblastoma

This was a retrospective as well as prospective study of fifty (50) cases of retinoblastoma in series during the study period from January 2005 to December 2015, conducted at Liaquat Medical College Eye hospital and Indus Medical College Hospital, Pakistan. The average incidence of retinoblastoma in cases presented in our department was 4.5 cases per year with 0.8 cases per year bilateral and 3.7 cases per year with unilateral involvement respectively. The minimum age in this series was 15 days and maximum age was 8 years, mean age being 3.46 years. Out of these 50 cases, 27(54%) were male and 23(46%) were females. In most of the cases diagnosis was made on clinical grounds and histopathological reports of the biopsy specimens. Other measures like plain X-ray orbit, CT scan, ultrasonography (A and B Scan) and studies of blood chemistry were used where ever needed. Majority of our cases were found to be in a fairly advanced stage (an aplasia grade severe) that is extending beyond the sclera in the orbital tissues. In 4 cases cat’s eye reflex noted. Out of these cases 3 were having involvement of the other eye extensively while in 4th case the other eye was not involved at all. Of the remaining cases 11(22%) were having vitreous seeding, 16(32%) showed extension up to the sclera and 22(44%) extended to involve the orbit. Only one case presented with the involvement of regional lymph nodes. All those cases that underwent modified exonerations were sent to radio isotope center for further management with radiation and/or chemotherapy depending upon the nature of spread. One patient who had the regional lymph nodes involvement, though did not show extra ocular spread in the orbit, underwent chemotherapy following enucleations.2 cases which were diagnosed in very early stage involving the posterior retina behind equator were managed by 60 Cobalt radioactive plaques insertion over the sclera at the site of lesion, left in place till such time as advised by the oncologist of the radio isotope center. A total of 28 enucleations and 19 modified exentrations were carried out. Recurrences were noted in 13 cases, no surgery was done in these cases and they were referred to radio isotope center at Jamshoro, Pakistan for further management with radiation or chemotherapy. In this series no case was found to have distant metastasis anywhere including long bones and other viscera of the body. 12 cases were lost to follow up at different stages of management and 6 of the cases died of unknown cause.

Characteristics, management, and outcome of patients with uveal melanoma treated by Iodine-125 radioactive plaque therapy in a single tertiary cancer center in Jordan

ObjectiveTo evaluate King Hussein Cancer Center experience in using Iodine-125 COMS radioactive plaque for treatment of Uveal Melanoma in Jordan. MethodsRetrospective case series of eyes with uveal melanoma treated by Iodine-125 COMS radioactive plaque therapy. Data collection required access to medical, radiology, Labs and pathology reports. Main outcomes studied includes: Demographics, tumor features, eye salvage, visual outcome, metastasis, and mortality. ResultsBetween September 2008 and March 2015, 28 eyes for 28 patients had intraocular uveal melanoma and treated by Iodine-125 radioactive plaque therapy. The mean age at diagnosis was 48 years and 16(57%) were males. The mean tumor thickness was 8 mm (range: 4–13 mm), and 27(96%) patients had medium or large size tumor. The radioactive plaques used had a median size of 16 mm (range: 12–20 mm). The mean apical dose was 83.5 Gy (range 81–87 Gy), and the median radiation rate was 7.25 (range: 4.5–13). At median follow up of 2 years (range 0.5–7 years), eye salvage rate was 93%. Four (15%) patients had distance metastasis, and 3(11%) were dead. Fifty percent of patient had visual acuity better than 20/200 at the last date of follow up. ConclusionOur preliminary results are encouraging and are comparable to another countries worldwide. The use of Iodine-125 COMs plaque therapy at the inspection of implementation of plaque therapy in the developing countries can lead to eye salvage in more than 90% of cases, and reserves functional vision in more than 50% of cases.

384P - Choice of adjuvant therapy in uveal melanoma: A retrospective analysis in China

Background: Despite effective local tumor control with radioactive plaque brachytherapy, endoresection, or enucleation, many UM (uveal melanoma) patients ultimately developed fatal metastases. This study aims to evaluate the adjuvant treatment of UM patients after surgery. Methods: Between March 2008 and Jan 2016, consecutively admitted uveal melanoma patients to Renal & melanoma department at the Beijing Cancer Hospital, were included in this cohort study. Choice of adjuvant therapy, recurrence-free survival and first metastatic sites, were analysed retrospectively. Results: In total, 97 uveal melanoma patients were investigated retrospectively. From this 97 pts, 57 were male, 47 pts had primary lesions in their left eyes, median age 46 year-old (20-72yrs). Most pts had UM arising from the choroid (97%). Seven pts were stage IV when first diagnosed. The rest 90 pts receive enucleation (61/90), endoresection (8/90), bradytherapy (21/90) respectively after initial uveal melanoma detection. Sixty-nine pts who received radical surgery of UM were divided in to observation group (n = 39), interferon group (n = 15), chemo group (n = 13), dendritic cell vaccination group (n = 2) with respect of post-surgery treatment. Of 69 pts, 57 had developed metastasis. Median replase-free survival was 2.6 years in observation group and 4.6 years in the chemo group (P < 0.05). Median replase-free survival (3.5+years) was not reached in the interferon group partly because 60% of them were admitted in recent 3 years. Liver is the most common first metastatic sites were (n = 38), the others included bone (n = 7), lung (n = 5), subcutaneous mets (n = 5). 29 pts had elevated LDH when developed distant metastasis, 9 of them were Grade 3(>5×ULN). Conclusions: Adjuvant chemotherapy or interferon might be reasonable options for patients with UM melanoma after surgery. We need more potent adjuvant therapy for this long term dormant but fatal disease. Legal entity responsible for the study: Beijing Cancer Hospital Funding: (Supported by the National Natural Science Foundation of China (81301984), Beijing Nova Program (XX2013027) and Program for New Century Excellent Talents in University (NCET-13-0007). Disclosure: All authors have declared no conflicts of interest.

Comparison of Gene Expression Profiling and Chromosome 3 Analysis by Fluorescent in situ Hybridization and Multiplex Ligation Probe Amplification in Fine-Needle Aspiration Biopsy Specimens of Uveal Melanoma

Purpose: The aim of this paper was to assess the concordance between results of DecisionDx-UM specific gene expression profiling (GEP) and fluorescence in situ hybridization (FISH) for chromosome 3 analysis, and between DecisionDx-UM GEP and multiplex ligation probe amplification (MLPA) in uveal melanoma undergoing intraoperative fine-needle aspiration biopsy (FNAB) for metastatic prognostication during brachytherapy. Methods: We retrospectively reviewed consecutive patients diagnosed with posterior uveal melanoma who underwent intraoperative FNAB prior to placement of an iodine-125 radioactive plaque between 2012 and 2014. Two cohorts of patients were identified: Cohort 1 - tumors in which both GEP and FISH results were obtained, and Cohort 2 - tumors in which both GEP and MLPA results were obtained. Results: Forty-four patients were identified for Cohort 1. FISH and GEP results were discordant in 7 tumors (15.9%). Forty-three patients were identified for Cohort 2. MLPA and GEP were discordant in 7 tumors (16.3%). Conclusions: Discordance between GEP and chromosome 3 status by FISH and MLPA occurred in our series at a rate of 15.9 and 16.3%, respectively. Caution must be advised when counseling a patient with a good-prognosis GEP “Class 1” result that the uveal tumor may actually harbor monosomy 3, which is associated with a poor prognosis for metastasis in nearly 20% of the patients.