Ruthenium-106 Brachytherapy and Central Uveal Melanoma

Abstract

Purpose Uveal melanoma (UM) is the most common primary ocular malignancy. The size of the tumor and its location are decisive for brachytherapy with β-emitting Ruthenium-106 (Ru-106) plaque. The treatment of juxtapapillary and juxtafoveolar UM may be challenging due to the proximity or involvement of the macula and optic nerve. High recurrence rates have been observed. Methods Central UM was defined as a lesion up to 5mm off the optic disc or fovea- radius of 5mm. Between January 2011 and July 2020, we treated 56 patients with Ru-106-brachytherapy. The clinical outcome for recurrence, visual acuity, and radiation-related toxicity was assessed. The follow-up was 66 (6-136) months. Results Of the 56 patients (56 eyes), eight patients (14%) suffered from local recurrence. Six relapsing UM of 19 patients (32%) were located close to the optic disc, and two patients had UM close to the macula (2/37, 5%), (p > 0,05). The overall rate of eye preservation was 89%. Visual acuity (VA) before treatments was 0,45 and was reduced to 0,26 after brachytherapy. Radiation retinopathy or opticopathy was detected in seven patients (13%), and radiation maculopathy in ten patients (17,9%). Six patients (11%) underwent enucleation due to recurrence or radiation-induced ophthalmopathy. Conclusion Therapy of central UM is challenging. We suggest, that central UM should be categorized as lesions laterally or medially to the fovea due to different likelihood of long-term control rates. Localization near the optic disc requires thoughtful management.