Ruthenium Brachytherapy for Uveal Melanoma, 1979–2003Survival and Functional Outcomes in the Swedish Population

Bergman, Louise; Nilsson, Bo; Lundell, G. E. F.; Lundell, Marie; Seregard, Stefan

doi:10.1016/j.ophtha.2004.11.038

Cited by 131 publications

(112 citation statements)

References 165 publications

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“…The higher rate of vision loss in our patients could be explained by greater tumor thickness as well as higher radiation dose to the sclera. All patients in our study had thick tumors, however, only 9.5% of enrolled patients reported by Bergman et al [14] had a tumor thickness more than 7 mm. The importance of tumor thickness on ultimate final visual acuity after brachytherapy has been emphasized in multiple reports [38,39].…”

Section: Discussioncontrasting

confidence: 61%

“…In a large analysis of 579 patients with posterior UM of all sizes treated with 106 Ru brachytherapy by Bergman et al [14], poor visual acuity at 2, 5, and 10 years was reported in 32.5%, 39.2%, and 44.8% of the patients. The higher rate of vision loss in our patients could be explained by greater tumor thickness as well as higher radiation dose to the sclera.…”

Section: Discussionmentioning

confidence: 98%

“…Although based on the COMS recommendation [21] tumors, up to 10 mm can be treated with 125 I brachy therapy, published studies from European countries [14,22,23] indicate that 106 Ru radioactive plaques is a choice of treatment for uveal melanomas with tumor height of 5.4 to 7 mm because of its limited depth of penetration. Therefore, the cut-off point of 7 mm was considered for thick tumor implication and inclusion criterion in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative treatments include brachytherapy [14,25,26], gamma-knife radiosurgery [27], proton beam radiation [28,29], fractionated stereotactic radiotherapy [30,31], and partial lamellar sclerouvectomy [32]. However, none of these alternative therapies has been evaluated prospectively.…”

Section: Discussionmentioning

confidence: 99%

“…A major concern for the use of 106 Ru plaques is its steep dose gradient in large tumors, meaning that the radiation dose falloff is quick, and in large UMs, the apex dose may not reach the recommended dose of 85 Gy [11]. Thus, some authors believe that 106 Ru plaques are not suitable for tumors with a thickness of 7 mm or more because the high dose to the outer sclera is a concern [12,13,14]. In contrast, multiple clinical studies have shown that 106 Ru brachytherapy can result in a favorable clinical outcome and complete regression even in large tumors [15,16].…”

Section: Purposementioning

confidence: 99%

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Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Naseripour¹,

Jaberi²,

Sedaghat³

et al. 2016

jcb

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Purpose: To evaluate the outcomes of ruthenium-106 ( 106 Ru) brachytherapy in terms of radiation parameters in patients with thick uveal melanomas.Material and methods: Medical records of 51 patients with thick (thickness ≥ 7 mm and < 11 mm) uveal melanoma treated with 106 Ru brachytherapy during a ten-year period were reviewed. Radiation parameters, tumor regression, best corrected visual acuity (BCVA), and treatment-related complications were assessed.Results: Fifty one eyes of 51 consecutive patients including 25 men and 26 women with a mean age of 50.5 ± 15.2 years were enrolled. Patients were followed for 36.1 ± 26.5 months (mean ± SD). Mean radiation dose to tumor apex and to sclera were 71 (± 19.2) Gy and 1269 (± 168.2) Gy. Radiation dose rates to tumor apex and to sclera were 0.37 (± 0.14) Gy/h and 6.44 (± 1.50) Gy/h. Globe preservation was achieved in 82.4%. Preoperative mean tumor thickness of 8.1 (± 0.9) mm decreased to 4.5 (± 1.6) mm, 3.4 (± 1.4) mm, and 3.0 (± 1.46) mm at 12, 24, and 48 months after brachytherapy (p = 0.03). Four eyes that did not show regression after 6 months of brachytherapy were enucleated. Secondary enucleation was performed in 5 eyes because of tumor recurrence or neovascular glaucoma. Tumor recurrence was evident in 6 (11.8%) patients. Mean Log MAR (magnification requirement) visual acuity declined from 0.75 (± 0.63) to 0.94 (± 0.5) (p = 0.04). Best corrected visual acuity of 20/200 or worse was recorded in 37% of the patients at the time of diagnosis and 61.7% of the patients at last exam (p = 0.04). Non-proliferative and proliferative radiation-induced retinopathy was observed in 20 and 7 eyes.Conclusions: Thick uveal melanomas are amenable to 106 Ru brachytherapy with less than recommended apex radiation dose and dose rates.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

See 3 more Smart Citations

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Naseripour¹,

Jaberi²,

Sedaghat³

et al. 2016

jcb

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Palladium-103 Plaque Radiation Therapy for American Joint Committee on Cancer T3- and T4-Staged Choroidal Melanomas

Semenova

Finger

2014

JAMA Ophthalmol

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IMPORTANCE Patients with larger choroidal melanomas are being treated with plaque radiation therapy.OBJECTIVE To report the methods and results of palladium-103 brachytherapy for American Joint Committee on Cancer, 7th edition, T3-and T4-sized choroidal melanomas. DESIGN, SETTING, AND PARTICIPANTSA retrospective analysis of the results of a clinical case series over a 10-year period of 47 consecutive patients with uveal melanoma. The patients were treated at The New York Eye Cancer Center, Beth Israel Comprehensive Cancer Center, or The New York Eye and Ear Infirmary between 2002 and 2012 and had a minimum follow-up of 6 months. Tumors had a mean preoperative apical tumor height of 8.6 mm and a mean largest basal diameter of 15.8 mm. MAIN OUTCOMES AND MEASURESWe analyzed, but were not limited to, data on the methods of radiation therapy, local tumor control, adverse effects, vision retention, and metastatic rate.RESULTS All patients completed therapy and received the prescribed tumor apex dose. At a median of 47 months (range, 6-125 months), the rate of local control was 91% and the rate of eye retention was 89%. The most common long-term brachytherapy-related complication was radiation maculopathy (66% of patients), followed by radiation optic neuropathy (51% of patients). One or both of these complications were diagnosed at a mean time of 16 months (range, 2-36 months) after brachytherapy. Secondary cataract developed in 36% of patients. Glaucoma developed in 17% of patients and resulted in enucleation in 4% of patients. The mean pretreatment visual acuity was 20/50 (range, 20/12.5 to hand motions), which evolved to a mean visual acuity of 20/100 (range, 20/20 to no light perception). Overall, 25 of 47 patients (53%) maintained 20/200 or better vision. Metastatic melanoma developed in 32% of patients.CONCLUSIONS AND RELEVANCE Palladium-103 ophthalmic plaque radiation therapy can be used as an eye-and vision-preserving treatment for relatively large American Joint Committee on Cancer T3-or T4-sized choroidal melanomas.

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Vision Loss Following Episcleral Brachytherapy for Uveal Melanoma

et al. 2016

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IMPORTANCE Vision loss following episcleral brachytherapy for uveal melanoma is difficult to predict for individual patients. OBJECTIVE To generate a risk calculator for vision loss following episcleral brachytherapy for uveal melanoma. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of data was conducted at a multispecialty tertiary care center in Cleveland, Ohio. All patients with primary ciliary body or choroidal melanoma treated with iodine 125 or ruthenium 106 episcleral brachytherapy between January 1, 2004, and December 30, 2013, were included. Univariate and multivariable Cox proportional hazards were used to determine the influence of baseline patient factors on vision loss. Kaplan-Meier curves (log-rank analyses) were used to estimate freedom from vision loss. Bootstrap resampling was performed to bias correct this estimate. MAIN OUTCOMES AND MEASURES Vision loss (to visual acuity [VA] worse than 20/50 and worse than 20/200). RESULTS A total of 311 patients were included in the study, with a mean (SD) age of 62 (14.7) years at start of treatment and a median follow-up of 36 months (interquartile range, 18-60 months). At presentation, VA was better than or equal to 20/50 in 199 patients (64%) and better than or equal to 20/200 in 289 patients (93%). By Kaplan-Meier analysis, VA less than 20/200 at 3 years was not associated with sex, diabetes, systemic hypertension, or hypercholesterolemia but was associated with history of ocular comorbidities, type of isotope (ruthenium 106 or iodine 125), and initial VA (>20/50 or <20/50). By multivariable analysis, age (hazard ratio [HR], 0.97; 95% CI, 0.94-1.00; P = .06), largest basal diameter (HR, 1.25; 95% CI, 1.16-1.34; P = <.001), total radiation dose to the fovea (HR, 1.03; 95% CI, 1.01-1.04; P = .001) and optic disc (HR, 1.01; 95% CI, 1.00-1.01; P = .005), and initial VA worse than 20/50 (HR, 1.85; 95% CI, 1.20-2.85; P = .005) were predictive of vision loss to a VA of less than 20/200. The concordance index for the full data set was 0.77. Using these data, an online risk calculator was developed to predict vision loss following episcleral brachytherapy. CONCLUSIONS AND RELEVANCE The vision prognostication tool presented herein needs to be validated by independent data sets. This tool may improve counseling for patients being evaluated for episcleral brachytherapy. At-risk individuals identified by this tool could be considered for inclusion into trials exploring prevention or treatment of radiation retinopathy and alternative therapies of uveal melanoma.

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Ruthenium Brachytherapy for Uveal Melanoma, 1979–2003Survival and Functional Outcomes in the Swedish Population

Cited by 131 publications

References 165 publications

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

Palladium-103 Plaque Radiation Therapy for American Joint Committee on Cancer T3- and T4-Staged Choroidal Melanomas

Vision Loss Following Episcleral Brachytherapy for Uveal Melanoma

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