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

Abstract

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.

Posterior uveal melanoma. Distribution of the sites of origin and patterns of tumour extent in the ocular fundus

“…The incidence, clinical findings, tumour characteristics and results of treatment have been described 6. Briefly, 60 women and 51 men were included in the study, with a median age of 66 years (mean, 64; range, 24–96 years) at the time of diagnosis.…”

Brachytherapy and endoresection for choroidal melanoma: a cohort study

“…Tumour recurrence following brachytherapy varies between 3.6% and 14.3% 3 20 21. The COMS demonstrated a recurrence rate of 10.3% (CI 8.0% to 13.2%) at 5 years 22.…”

Management of Radiation Maculopathy

“…The major modifiable risk factor for development of radiation maculopathy is the total dose of radiation to the macula [18]. Newer designs/techniques of delivering radiation should be explored [6,7,8,13,19,20]. The other option of attenuating intraocular radiation by temporarily filling the vitreous cavity with silicone oil is also under investigation [21].…”

“…The risk of radiation maculopathy is increased in the presence of comorbidities such as diabetes and prior chemotherapy [6,7,8]. In addition, several modifiable radiation factors such as the type of radiation delivery method (teletherapy vs. brachytherapy), fractionation, type of radiation isotope used for brachytherapy (ruthenium-106 vs. iodine-125) and the total dose delivered to the macula also significantly influence the risk of developing radiation maculopathy [9].…”