106Ruthenium eye plaque brachytherapy in the management of medium sized uveal melanoma

Abstract

Background: To evaluate 106 Ruthenium Brachytherapy in management of medium sized uveal melanoma, with emphasis on 5-year outcome and toxicity. Methods: From 2007 to 2015, 39 patients were treated with 106 Ru eye plaques brachytherapy. At the time of diagnosis, the mean tumor depth was 3.7 mm (±SD:1.6). Mean dose at the apex of the tumor was 141.4 Gy (± SD: 12.1 Gy). The mean sclera dose was 557.7 Gy (± SD: 257.3 Gy). Results: Mean follow-up was 69.5 months (± SD: 53.8 months). 34 patients (87.1%) remained free of recurrence. In 26 (66.7%) patients a total regression was achieved after a median period of 12 months (Range: 3-60 mon.). By the final examination, the visual acuity of 26 (66.7%) patients was better than 20/200. 12 (30.7%) patients had a visual acuity better than 20/40. Retinopathy was detected in 11 (28.2%) patients. After treatments only 1 (5.1%) patients had active vascular changes by the last examination. Moderate optic neuropathy was observed in 4 (10.3%) patients. Cataract development was diagnosed in 21 (53.8%) patients, although 16 (41%) of them had bilateral cataract development. Special emphasis was made on patients with larger tumors. Twelve out of the 39 patients had a tumor with a depth of 5mm or more. There was no significant difference neither in local control (75 % in tumors ≥5mm versus 92.6 % in tumors <5mm) nor in side effects between both groups. Conclusions: Our study proved 106 Ru -brachytherapy to be an excellent treatment option with regard to tumor control and preservation of the visual acuity in well-selected patients. The data suggest that this treatment is also suitable for tumors with a depth of more than 5mm.

Preliminary Results of Uveal Melanoma Treated With Iodine-125 Plaques: Analysis of Disease Control and Visual Outcomes With 63 Gy to the Target Volume

“…High-energy cobalt-60 ( 60 Co) episcleral discs were popularized by Stallard in the 1960's (7). Since that time, several other isotopes have been utilized including beta electron emitters Ruthenium/ Rhodium-106 ( 106 Ru/ 106 Rh), Strontium-90/Yttrium-90 ( 90 Sr/ 90 Y) in solid plaques, and low-energy photon emitters Iodine-125 ( 125 I), Palladium-103 ( 103 Pd) and Casmium-131 ( 131 Cs) in seeded plaques (8)(9)(10)(11)(12). Compared to solid plaques, seeded photon plaques can be adjusted to shape the radiation dose to the tumor volume, making them more customizable to tumor shape and dimensions (11).…”

“…Compared to solid plaques, seeded photon plaques can be adjusted to shape the radiation dose to the tumor volume, making them more customizable to tumor shape and dimensions (11). In addition, photon emitting isotopes are further penetrating, so they can be used for tumor apical heights higher than 6mm, which is typically the limit of beta electron plaques like 106 Ru (10,12).…”

“… 7 Since that time, several other isotopes have been used, including beta electron emitters ruthenium/rhodium-106 ( 106 Ru/ 106 Rh), strontium-90/yttrium-90 ( 90 Sr/ 90 Y) in solid plaques, and low-energy photon emitters iodine-125 ( 125 I), palladium-103 ( 103 Pd), and casmium-131 ( 131 Cs) in seeded plaques. 8 , 9 , 10 , 11 , 12 Compared with solid plaques, seeded photon plaques can be adjusted to shape the radiation dose to the tumor volume, making them more customizable to tumor shape and dimensions. 11 In addition, photon emitting isotopes are further penetrating, so they can be used for tumor apical heights higher than 6 mm, which is typically the limit of beta electron plaques like 106 Ru.…”

“… 11 In addition, photon emitting isotopes are further penetrating, so they can be used for tumor apical heights higher than 6 mm, which is typically the limit of beta electron plaques like 106 Ru. 10 , 12 …”