Long-term survival after ruthenium plaque radiotherapy for uveal melanoma. A meta-analysis of studies including 1,066 patients

Abstract

ABSTRACT.Purpose: Most case series of patients managed by brachytherapy for uveal melanoma are small and survival data show considerable inter-study variation. The aim of this study was to summarise similarly structured case series by meta-analysis. Methods: A systematic review generated 5 similarly structured case series including survival data for 1,066 patients treated by ruthenium plaque radiotherapy for uveal melanoma. After assessing the inter-study clinical heterogeneity, data were weighed for study size and pooled. Results: Patient and radiotherapy characteristics were largely homogenous, but tumour size varied considerably between studies. The 5-year melanoma-related mortality rate was 6% for small and medium tumours (T1/T2) and 26% for large (T3) tumours. The 5-year and 10-year melanoma-related mortality rates for a balanced set of tumours with small, medium and large tumours being present in similar proportions were 14% and 22%, respectively. Conclusion: Case series of patients with uveal melanoma managed by brachytherapy may be pooled to increase sample size and study power. The present estimate of survival following ruthenium plaque radiotherapy compares favourably with previously summarised data of survival after enucleation for similarly sized tumours.

On the Actual State of Industrial Quality Assurance Procedures with Regard to 106Ru Ophthalmic Plaques

“…Furthermore, corneal pannus in dogs [10] is responsive to radiation therapy with 90 Sr, and long-term benefit can be achieved with minimal side effects. In radiotherapy of intraocular tumors, e.g., in the case of malign choroid melanomas, episcleral brachytherapy with 106 Ru ophthalmic plaques has proven to be successful [14,[16][17][18][19][20]. In a study [12], the authors reported that in the course of an internal clinical acceptance test of 106 Ru ophthalmic plaques, manufactured by the company Bebig, Berlin, Germany, the following shortcomings of industrial quality assurance, which are relevant to therapy, were discovered: risk of leakage as well as inconsistent dose rate specifications in the manufacturer's certificates, covering a range of 111%.…”

NCS Report 14: Quality control of sealed beta sources in brachytherapy

“…The film color darkens during the first days after irradiation. At [25][26][27][28][29][30] o C are estimated to be no more than a few percent when a 24 hours post-irradiation time is used.…”

“…A more limited application of beta sources is the treatment of choroidal melanoma [27] and retinoblastoma [28]. These malignant diseases are treated with concave ruthenium plaques that can be stitched to the eye.…”

Tumour-lysis-related elevation of intraocular pressure following high-dose-rate brachytherapy for choroidal melanoma

“…7 Following the pioneering works of Moore 8 and Stallard 9 from the UK, advances in radiation physics have led to the development of lowenergy plaques such as ruthenium 106 plaque 10 which is predominantly used in Europe, and iodine 125 plaque 11 used in North America. Data derived from a large number of patients treated either with ruthenium 106 12 or iodine 125 plaque 11 have shown that plaque radiotherapy is effective in controlling the primary tumour, preserving the globe in the majority of treated patients, and preserving useful vision in up to half of the treated patients. However, plaque radiotherapy does not offer any survival advantage over enucleation.…”