Treatment of non-resectable malignant iris tumours with custom designed plaque radiotherapy.

Abstract

Background-Plaque radiotherapy is the most common method of managing posterior uveal melanoma but its use for iris melanoma and iris metastases has not yet been evaluated. Methods-Fourteen patients with nonresectable iris melanoma and four with iris metastasis were treated with plaque radiotherapy. The tumour response to treatment and the local side effects of the radioactive plaque were evaluated. Results-In the iris melanoma group over a mean follow up of 26 (range 6-75) months, the tumour regressed in 13 of the 14 patients (93/o) and recurred as diffuse seeding in one patient (70/%). Despite large doses of radiation given transcorneally, the cornea developed epitheliopathy, abrasion, and oedema in only one case each. The major radiation side effects were localised iris vasculopathy without glaucoma in two cases, posterior synechiae in five cases, and cataract in six cases. In the iris metastasis group, tumour regression was observed in all four patients (100%) and radiation side effects were not evident over the relatively short mean follow up period of 8 (range 4-9) months. AUl of the 14 patients with irradiated iris melanoma have remained systemically healthy without metastasis while three of the four patients with irradiated iris metastases have died of metastases from the primary neoplasm. Conclusion-Custom designed plaque radiotherapy appears to be an effective alternative method of controlling nonresectable diffuse iris melanoma and solitary iris metastasis and has relatively few side effects. (BrJ7 Ophthalmol 1995; 79: 306-312)

Ruthenium plaque radiation therapy for iris and iridociliary melanomas

“…The first group of iris melanoma patients treated with plaque radiation therapy with iodide (I-125) was reported in 1995 (Shields et al 1995). These patients showed a good tumour control and few side-effects.…”

“…Keunen, 2 initially introduced for posterior uveal melanoma in 1960s, had until recently not been used for anterior uveal melanoma in view of potential risks of radiation on the cornea and lens. In 1995, Shields et al were the first to report about the treatment of iris melanomas with plaque radiation therapy using iodide-125 with a good tumour control (Shields et al 1995), followed by reports on the effectiveness of palladium-103 and other plaques (Finger 2001;Shields et al 2003). The first abstract of ruthenium-106 (Ru-106) plaque brachytherapy for iris melanomas in a cohort of 24 consecutive patients with a short follow-up was presented by our group (Kuipers et al 2002;Keizer et al 2004).…”

“…(Arensten & Green 1975;Shields et al 1995Shields et al , 2003Naumann & Rummelt 1996;Finger 2001;Damato et al 2005;Fernandes et al 2009). Plaque radiation therapy,…”

Plaque radiotherapy treatment with ruthenium-106 for iris malignant melanoma

“…Shields et al 6,7 reported on the outcome of using iodine-125 plaque radiotherapy for iris melanoma in 1995 and 2003. The incidence of cataract formation was found to be 70%.…”

“…2 In cases of unresectable iris melanoma or in tumours with extensive seeding, plaque radiotherapy, proton beam irradiation, or enucleation can be used. [6][7][8] Enucleation is the treatment of choice in cases of diffuse melanoma where more than half of the iris and trabecular meshwork are invaded by tumour or when there is uncontrollable glaucoma.…”