Impact of Dose Rate on Clinical Course in Uveal Melanoma after Brachytherapy with Ruthenium-106

Abstract

These data suggest that a higher dose rate may confer a lower risk for metastatic spread, but may be associated with more side effects and more pronounced visual decline.

High dose rate and low dose rate ruthenium brachytherapy for uveal melanoma. No association with ocular outcome

“…Minimal but conflicting data have been published; some suggest a better effect when using high dose rate brachytherapy,5 others failed to detect an obvious benefit 6 7. Mössbock et al retrospectively studied 45 patients divided in two apex dose rate groups (seemingly arbitrarily divided in <4 Gy/h or ≥4 Gy/h).…”

“…Recently published guidelines for iodine-125 episcleral brachytherapy of uveal melanoma suggest the use of a minimum dose rate of 0.6 Gy/h at the tumour apex, but there are no similar guidelines for ruthenium brachytherapy. Recent data suggest that high dose rate ruthenium brachytherapy may be associated with a lower metastatic rate and lower local recurrence rate when dose rate at the tumour apex exceeds 4 Gy/h 5. Results from other reports, however, are conflicting and have not been able to correlate local tumour recurrence with the tumour apex dose rate 6 7…”

The Effectiveness and Safety of Proton Radiation Therapy for Indications of the Eye

“…Ruthenium applicators are suitable for the treatment of dome-shaped melanomas that do not exceed 5 mm in thicknes [75], iodine applicators are used for medium-sized melanomas, and proton radiation is typically used for high-risk cases. A recent study on the effects of ruthenium-106 showed that a higher dose reduces the risk of metastasis, but it may be associated with more side effects [56]. Only one study directly compared the three treatments for uveal melanoma [71].…”

Stereotactic Photon Beam Irradiation of Uveal Melanoma: Indications and Experience at the University of Vienna since 1997

“…Most uveal melanomas are currently treated by eye-preserving radiotherapy (1,2,3). No advantage of enucleation of posterior uveal melanoma (< 12 mm) could be demonstrated in multiple studies (e.g.…”