Long-term Results of Iodine 125 Irradiation of Uveal Melanoma

Packer, Samuel; Stoller, Scott D.; Lesser, Martin; Mandel, Francine S.; Finger, Paul T.

doi:10.1016/s0161-6420(92)31899-8

Cited by 141 publications

(55 citation statements)

References 23 publications

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“…A randomized study [36] to compare the results of helium ion irradiation versus I125-brachytherapy showed that visual acuity had decreased by _> 4 lines in 69% of each group. Another study on visual acuity after II25-therapy [37] revealed that 49 (78%) of 63 patients had an acuity decreased to <_ 6/30, or an acuity which had decreased 2 lines or more. It was concluded that the eye encounters significant morbidity after I125-irradiation.…”

Section: The Importance Of Long-term Visual Acuity Datamentioning

confidence: 98%

Uveal melanoma: updated considerations on current management modalities

1995

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Published data on growth rates of uveal melanomas and effects of treatment modalities raise important considerations. Dissemination from uveal melanomas starts after the tumour is larger than 7 mm diameter; growth from 7 to 10 mm diameter increases the risk of metastases incrementally to approximately 16%. Estimations of turnout doubling times indicate that metastatic death before 8 years is nearly always due to pre-therapeutic dissemination so that the impact on survival by therapy can only be assessed thereafter. Histopathology on irradiated melanomas reveals that reproductive activity has not been suppressed and the anticipated (and unfavourable) risk of metastases is not balanced by poor post-irradiation visual acuity. Also the psychological well-being of a patient with a functional fellow eye is better after primary enucleation. Conservative management is most appropriate for: small melanomas, patients with a short life expectancy, melanomas in a single functioning eye, and patients refusing enucleation.Optimum treatment of any form of neoplastic disease by modern therapeutic modalities should ideally be based on an accurate knowledge of the biological behaviour of the specific neoplastic process. With regard to ocular melanomas, there are serious gaps in knowledge concerning growth rates in situ and in the documentation of the time intervals between the presentation of the primary tumour and the appearance of metastases. The rarity of the tumour necessitates careful accumulation of data, so that an adequate analysis can be made of the claimed success of cure rates. Equally important, the side effects and the complications of treatment should be the subject of careful scrutiny. In this communication the literature on the relevant aspects of melanoma biology and current treatment modalities is critically analysed. Tumour biology Tumour doubling timeInformation on tumour doubling time of uveal melanomas was introduced in 1980 [1] and updated reviews were provided in 1987 [2] and in 1992 [3]. From this data it was possible to estimate the risk of metastatic disease in relation to the dimensions of the tumour. The application of meta analysis provided by Diener-West and associates [4] and Markowitz et al. [5] has indicated that a radical reappraisal of the current philosophy of management is required. When do uveal melanomas metastasize ?In 1984, an editorial in the American Journal of Ophthalmology stated that 'it is unclear at what stage in its course a uveal melanoma develops the capacity to metastasize ' [6]. However an analysis of the data then available in the literature provided evidence which indicated that metastatic disease does not occur until

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Section: The Importance Of Long-term Visual Acuity Datamentioning

confidence: 98%

Uveal melanoma: updated considerations on current management modalities

1995

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“…The local control rate with plaque therapy is between 90 and 95%. [32][33][34][35][36] Plaques can also be used after local resection, transsleral, or transretinal, in which case only the tumour bed would be treated to 2-3 mm by 50-60 Gy I-125 or 100 Gy Ru-106. 37 Proton therapy has been used for uveal melanomas since 1975.…”

Section: Radiotherapy For Ocular Tumours C Stannard Et Almentioning

confidence: 99%

Radiotherapy for ocular tumours

Stannard

Sauerwein

Maree

et al. 2012

Eye

102

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Ocular tumours present a therapeutic challenge because of the sensitive tissues involved and the necessity to destroy the tumour while minimising visual loss. Radiotherapy (RT) is one of several modalites used apart from surgery, laser, cryotherapy, and chemotherapy. Both external beam RT (EBRT) and brachytherapy are used. Tumours of the bulbar conjunctiva, squamous carcinoma and malignant melanoma, can be treated with a radioactive plaque: strontium-90, ruthenium-106

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“…[16][17][18][19] We believe that the consistent use of iodine as the radioactive source and the relatively high tumour apex dose of 100 Gy have contributed to the low recurrence rate. As tumour regrowth has been associated with a poor survival prognosis, 9,20,21 an effective local tumour control is essential in brachytherapy of uveal melanoma.…”

Section: Discussionmentioning

confidence: 97%

“…When differences in patient selection, tumour characteristics, and follow-up are taken into consideration, the mortality rates in our study are generally comparable to those reported by others. 2,9,18,22,23 Several studies have shown that the size of the uveal melanoma is a risk factor for subsequent metastases. 22,24,25 In the multivariate analyses, we found that large basal tumour diameter was the only significant predictive factor for metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Posterior uveal melanoma treated with I-125 brachytherapy or primary enucleation

Krohn

Monge

Skorpen

et al. 2007

Eye

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Purpose To study the incidence, clinical findings, and tumour characteristics of posterior uveal melanoma in Western Norway, and to report the results of a consistent treatment strategy (I-125 brachytherapy or primary enucleation) over a 13-year period. Methods The clinical records of all patients with posterior uveal melanoma referred between January 1993 and December 2005 were reviewed. Clinical data, radiation parameters, visual outcome, and mortality were analysed in a dedicated database. Results The study included 111 consecutive patients. The annual age-adjusted incidence (per million population) of posterior uveal melanoma was 8.5 for women and 8.9 for men. Fifty-six patients underwent I-125 brachytherapy, 52 were enucleated, and three received no treatment. The median follow-up time was 36 months (mean, 52 months; range, 2 months to 13 years). In the brachytherapy group, two eyes were enucleated owing to tumour recurrence and two because of neovascular glaucoma. A visual acuity of 0.1 or better, present in 87% of the patients before brachytherapy, was retained in 40% after a median follow-up of 61 months. After brachytherapy, the 5-and 10-year melanomaspecific mortality rates were 13.4 and 23.8%, respectively. The corresponding mortality rates for patients treated with primary enucleation were 49.5 and 49.5%. Conclusion After brachytherapy, many patients lost useful vision due to radiationinduced complications. The probability of retaining the eye was high and only two patients experienced recurrent tumour growth. The mortality rates compare well with published series, and the differences in tumour size explain the difference in mortality between the two treatment groups.

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Long-term Results of Iodine 125 Irradiation of Uveal Melanoma

Cited by 141 publications

References 23 publications

Uveal melanoma: updated considerations on current management modalities

Uveal melanoma: updated considerations on current management modalities

Radiotherapy for ocular tumours

Posterior uveal melanoma treated with I-125 brachytherapy or primary enucleation

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