Anatomical and functional outcomes after endoresection and adjuvant ruthenium brachytherapy for uveal melanoma: a single center case series

Abstract

Purpose: To evaluate the anatomical and functional outcomes after endoresection and adjuvant Ruthenium(Ru)-106 brachytherapy for uveal melanoma (UM). Methods: Retrospective case series of 15 UM patients (15 eyes) treated at our centre (Careggi University Hospital, Florence). Results: Six patients (40%) were male and 9 females (60%). The mean age of patients at the time of treatment was 61.6 years (±19.41). The mean BCVA at baseline was 20/50. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.14 mm (± 2.05), and the mean largest basal diameter was 11.2 mm (± 1.92). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while 4 patients (26.7%) were treated with a “salvage endoresection” after primary treatment failure (previous radiation treatment). The mean follow-up time was 28.9 months (± 10.6). Thirteen out of 15 patients were alive and with no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case patient underwent enucleation for disease recurrence. The overall-survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/40. Treatment was well tolerated, without significant complications. Conclusions: Endoresection is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It allows to control melanoma and avoid enucleation, reduces the radiation-related complications, and provides tumor tissue for chromosomal analysis and prognostic testing.