PurposeThe aim of the study was an evaluation of I-125 brachytherapy patients with uveal melanoma with special consideration for the relationship of the treatment results and the irradiation dose applied to the tumor apex.Material and methodsMedical records of 344 adults with uveal melanoma treated with I-125 brachytherapy in the Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College in Cracow, Poland were retrospectively analyzed. The study was conducted between 2003 and 2012, and the study group was divided into two subgroups depending on the irradiation dose applied to the top of the tumor: 80 Gy to 100 Gy (n = 177) and 100 Gy to 120 Gy (n = 167).ResultsIt was found that the height of the tumor and the largest diameter of the tumor base decreased with every consecutive follow-up measurement and differed significantly in all comparisons (p < 0.0001). No significant correlation between frequency of complications was found between both study groups (χ2 = 0.27; p = 0.6067). The correlation between survival and the irradiation dose as applied to the tumor top was statistically irrelevant (χ2 = 0.44; p = 0.5084). A logistic regression model showed that patient survival depended on the largest diameter of the base and the height of tumor (p = 0.0216), and the risk of death was larger as these dimensions increased (IR, 1.17). An increase of the largest diameter of the base by 1 mm meant a 17% increase in chances of death. In 13.4% of cases, an enucleation was necessary.ConclusionsThe treatment of choroidal melanomas with I-125 iodine isotope brachytherapy is an efficient and recommended method of treatment and in many cases, an alternative to the enucleation of an eyeball.

Purpose: A retrospective evaluation of effectiveness of brachytherapy or enucleation in treatment of rare form of uveal melanoma: ring melanoma.Material and methods: Analysis comprised 49 patients treated from 2000 to 2019 for ring melanoma involving ciliary body. In 15 patients, primary treatment consisted of brachytherapy ( 106 Ru or 125 I), whereas in 34 patients, eyeballs were enucleated. The evaluation concerned differences between analyzed groups relating to the clinical and histopathological features as well as overall survival, cancer-specific overall survival, and disease-free survival.Results: No significant differences between the analyzed groups were found with regards to clinical and histopathological features, apart from intra-ocular pressure (increased in the enucleation group). Kaplan-Meier analysis did not reveal any significant differences between the group treated with enucleation and the group undergoing brachytherapy, both with regards to overall survival (p = 0.325) and cancer-specific overall survival (p = 0.477). A significant difference was observed in disease-free survival (p = 0.009), which was significantly shorter in the group undergoing brachytherapy. In the analysis of parameters of the applied brachytherapy, no significant differences between patients with and without local recurrence were found. Mean observation period was 350.8 weeks (range, 24-996 weeks, SD = 231.6). A local recurrence occurred in 11 (22.4%) patients, including 3 (6.1%) in enucleation and 8 (16.3%) after brachytherapy groups. Metastasis developed in 11 (22.4%) cases after a mean follow-up of 133 weeks (33.25 months), range 3-655 weeks.Conclusions: Preliminary observations may suggest that brachytherapy in this rare form of uveal melanoma, such as ring melanoma involving the ciliary body, may be taken into consideration as a useful alternative to enucleation. However, the confirmation of such an approach requires a larger patients' group to be gathered, and also a longer follow-up period. This is especially important in patients with a good baseline visual acuity in the affected eye, or when the neoplasm is present in the remaining eye with vision.

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The eyeball is the most common extracutaneous location of melanoma. UM is a huge threat to a patient’s life. It metastasizes distantly via blood vessels, but it can also spread locally and infiltrate extraocular structures. The treatment uses surgical methods, which include, among others, enucleation and conservative methods, such as brachytherapy (BT), proton therapy (PT), stereotactic radiotherapy (SRT), stereotactic radiosurgery (SRS), transpupillary thermotherapy (TTT) and photodynamic therapy. The key advantage of radiotherapy, which is currently used in most patients, is the preservation of the eyeball with the risk of metastasis and mortality comparable to that of enucleation. Unfortunately, radiotherapy very often leads to a significant deterioration in visual acuity (VA) as a result of radiation complications. This article is a review of the latest research on ruthenium-106 (Ru-106) brachytherapy, iodine-125 (I-125) brachytherapy and proton therapy of uveal melanoma that took into account the deterioration of eye function after therapy, and also the latest studies presenting the new concepts of modifications to the applied treatments in order to reduce radiation complications and maintain better visual acuity in treated patients.

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