Results following episcleral ruthenium plaque radiotherapy for posterior uveal melanoma The Swedish experience

Abstract

ABSTRACT. The Swedish experience of ruthenium 106 plaque radiotherapy for posterior uveal melanoma includes 266 patients treated between 1979 and 1995. The median dose delivered at the tumour apex was 100 Gy and the median follow-up after radiotherapy was 3.6 years (range = 0.5 to 12.5 years) with no patient being lost to follow-up. Visual acuity deteriorated moderately following treatment but appeared to stabilize after 5 to 6 years. Treatment failure defined as enucleation following plaque treatment occurred in 46 of the 266 (17%) studied patients. The cumulative 5-year probability of retaining the eye after radiotherapy was 82% and by univariate analysis tumour height, tumour diameter and tumour stage each predicted subsequent treatment failure, whereas in multivariate analysis no single covariate retained a predictive value. Forty-five of the 266 patients died of any cause during follow-up; 27 of these deaths were melanoma-related. The cumulative 5-year survival proportion (based on melanoma-related deaths only) was 86%. Death in metastatic disease appeared to be more common among patients that failed ruthenium plaque radiotherapy, however these patients also tended to have large tumours.

Dose De-Escalation With Gamma Knife Radiosurgery in the Treatment of Choroidal Melanoma

“…Current treatment strategies include resection, enucleation, brachytherapy and stereotactic radiation (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Disease prognosis is variable, and the optimal treatment paradigm has yet to be defined.…”

The retina dose-area histogram: a metric for quantitatively comparing rival eye plaque treatment options

“…Ru plaques are a viable alternative to I-125 and Pd-103 plaques for tumors less than 4 mm tall. The Ru plaques are widely used in Europe [2, 3, 18, 19]. The plaque in Figs.…”

Gamma knife stereotactic radiosurgery yields good long-term outcomes for low-volume uveal melanomas without intraocular complications

“…19 Although a high control rate is achieved with plaque brachytherapy, this technique is associated with a high complication rate due to the high doses of radiation the tumor periphery is exposed to. 16,17,20 In a series of 1019 uveal melanoma patients, Shields and colleagues reported an average dose of 77 Gy at the tumor apex. Tumor regrowth (51%) and vascular glaucoma as a consequence of radiation affecting the nearby tissues (31%) were shown to be the major causes of secondary enucleation.…”

“…In recent years, eye-saving procedures have become more widespread, and these include photocoagulation, transpupillary thermotherapy, radiotherapy, local resection, chemotherapy, immunotherapy, and stereotactic radiosurgery. [12][13][14][15][16][17] Surgical treatment may be associated with postoperative pain, infection, insufficient resection, and secondary eye loss, and it has no superiority over GKS in terms of recurrence. 10,13 Chemotherapy and immunotherapy have no curative role; the main objective of treatment in uveal melanoma is to achieve local disease control, and no medical treatment alone can assure this outcome.…”

“…17,20 Seregard and colleagues reported deterioration in visual activity and a secondary enucleation rate of 17% after plaque brachytherapy with a median dose of 100 Gy at the tumor periphery. 16 Besides the advantages of being non-invasive and easier for the patient to tolerate, radiosurgery provides a single day treatment that can be completed within a few hours. 21,22 No other technique offers the same convenience for the patient.…”