125I plaque brachytherapy for anterior uveal melanomas

Abstract

Purpose To describe the results of 125 I plaque brachytherapy of uveal melanomas anterior to the equator in terms of local control and the associated complications while trying to identify their risk factors (patients' demographic data, ocular, and tumour characteristics). Methods Retrospective analysis of a series of patients treated by 125 I between 1990 and 2000 in a single institution. The main outcome measures are evaluation of local tumour control and complications associated with 125 I plaque brachytherapy of these melanomas. Results During the study period, 136 patients were treated for an anterior tumour. The median follow-up was 62 months. The overall 5-year survival rate was 88.3%, the 5-year metastasis rate was 4% and the local recurrence rate was 1.5%. The mean final visual acuity was 20/40. The ocular complications most frequently observed at 5 years were cataract (50.3%), maculopathy (18.3%), intraocular inflammation (19.3%), and glaucoma (10.6%). Optic neuropathy, retinal detachment, keratitis, and intravitreous haemorrhage were also described. Risk factors for worse survival were age greater than 65 years and initial tumour thickness greater than 4 mm. Risk factors for the development of cataract were age more than 65 years old, male gender, and tumour diameter of more than 10 mm. Risk factors for intraocular inflammation were tumour thickness of more than 4 mm and invasion of the ciliary body. Conclusions The use of 125 I plaque brachytherapy to treat melanomas situated anterior to the equator allows good local and systemic control with a low rate of macular and optic disc complications. The most frequent complication was cataract formation.

Ocular complications following I-125 brachytherapy for choroidal melanoma

“…In contrast, another study found that keratitis was present in 20.9% of patients at 2 years after treatment, and this decreased to 2.8% of patients by 5 years after treatment. 10 Few other studies using I-125 brachytherapy describe this complication. Symptomatic treatment is recommended and includes topical lubricants and lacrimal punctual occlusion.…”

“…57 Other studies have also supported factors, such as radiation dose, greater tumour size, and close proximity to macula and optic disc, increase the risk of visual decline. 5,9,10,16,19,20,34 Quivey et al 9 found that a tumour thickness greater than 6 mm was correlated with decreased visual acuity. Specific thresholds for locations correlating with an increased risk included tumour located in less than 3 mm from or within 3 disc diameters of the fovea or optic nerve.…”

“…Increasing tumour height has been shown to decrease the time to cataract development and a greater tumour diameter increases the risk of cataract. 10,12 The location of the tumour is also important as treatment of an anterior tumour puts the plaque in closer proximity to the lens, therefore exposing the lens to more radiation. Fontanesi et al 17 found that cataract developed much earlier with anterior tumours (median 11 months post-plaque) compared with posterior tumours (median 26 months post-plaque) with a greater proportion of cataract occurring in eyes with anterior tumours.…”

“…Systemic conditions, such as diabetes and coronary artery disease, were also correlated with an increased risk of visual decline. 5,10,28,57 Episclera and sclera…”

Core Endoresection as Neoadjuvant Treatment of Uveal Melanoma

“…Radiotherapy of such a large tumour was likely to cause radiation retinopathy and neovascular glaucoma (i.e. 'toxic tumour syndrome') [2] . These risks were higher with the anterior location of the tumour [2,3] making also the scleral necrosis more probable [3] .…”