Purpose. To evaluate our community-based institutional experience with plaque brachytherapy for uveal melanomas with a focus on local control rates, factors impacting disease progression, and dosimetric parameters impacting treatment toxicity. Methods and Materials. Our institution was retrospectively reviewed from 1996 to 2011; all patients who underwent plaque brachytherapy for uveal melanoma were included. Follow-up data were collected regarding local control, distant metastases, and side effects from treatment. Analysis was performed on factors impacting treatment outcomes and treatment toxicity. Results. A total of 107 patients underwent plaque brachytherapy, of which 88 had follow-up data available. Local control at 10 years was 94%. Freedom from progression (FFP) and overall survival at 10 years were 83% and 79%, respectively. On univariate analysis, there were no tumor or dosimetric treatment characteristics that were found to have a prognostic impact on FFP. Brachytherapy treatment was well tolerated, with clinically useful vision ( 20/200) maintained in 64% of patients. Statistically significant dosimetric relationships were established with cataract, glaucoma, and retinopathy development (greatest ). Conclusions. Treatment with plaque brachytherapy demonstrates excellent outcomes in a community-based setting. It is well tolerated and should remain a standard of care for COMS medium sized tumors. 1. Introduction Uveal melanoma is an uncommon cancer, with age-adjusted incidence rates of 4.3 new cases per million [1]. Mortality however is not rare, with metastases present in up to 20–39% of patients at 20 years, and tumor related death ranging from 17–20% at 20 years [2]. There have been multiple investigations into appropriate treatment options, and current accepted standards range from observation to enucleation, all dependent on the size and characteristics of the tumor [3–5]. Brachytherapy is frequently utilized for medium sized tumors (apical height 3–10？mm and basal diameter 5–16？mm) and has been shown to be equivalent to enucleation for tumors in this category [3]. Treatment delivery is nevertheless quite complex, and it has been recommended to only undertake this treatment approach at medical centers with the appropriate expertise [6]. Accordingly, recommendations have been made by the American Brachytherapy Society regarding appropriate treatment delivery and planning [6]. While the efficacy of plaque brachytherapy has been well established in large institutional practices that are well versed in its implementation [7–9], smaller
References
[1]
A. D. Singh, L. Bergman, and S. Seregard, “Uveal melanoma: epidemiologic aspects,” Ophthalmology Clinics of North America, vol. 18, no. 1, pp. 75–84, 2005.
[2]
C. L. Shields, S. Kaliki, M. Furuta, A. Mashayekhi, and J. A. Shields, “Clinical spectrum and prognosis of uveal melanoma based on age at presentation in 8,033 cases,” Retina, vol. 32, pp. 1363–1372, 2012.
[3]
Collaborative Ocular Melanoma Study Group, “The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report no. 28,” Archives of Ophthalmology, vol. 124, no. 12, pp. 1684–1693, 2006.
[4]
B. S. Hawkins and Collaborative Ocular Melanoma Study Group, “The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma: IV. Ten-year mortality findings and prognostic factors. COMS report number 24,” American Journal of Ophthalmology, vol. 138, pp. 936–951, 2004.
[5]
J.-P. Caujolle, H. Mammar, E. Chamorey, F. Pinon, J. Herault, and P. Gastaud, “Proton beam radiotherapy for uveal melanomas at nice teaching hospital: 16 years' experience,” International Journal of Radiation Oncology Biology Physics, vol. 78, no. 1, pp. 98–103, 2010.
[6]
S. Nag, J. M. Quivey, J. D. Earle, D. Followill, J. Fontanesi, and P. T. Finger, “The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas,” International Journal of Radiation Oncology Biology Physics, vol. 56, no. 2, pp. 544–555, 2003.
[7]
P. de Potter, C. L. Shields, J. A. Shields, J. R. Cater, and L. W. Brady, “Plaque radiotherapy for juxtapapillary choroidal melanoma: visual acuity and survival outcome,” Archives of Ophthalmology, vol. 114, no. 11, pp. 1357–1365, 1996.
[8]
K. Gündüz, C. L. Shields, J. A. Shields, J. Cater, J. E. Freire, and L. V. Brady, “Radiation retinopathy following plaque radiotherapy for posterior uveal melanoma,” Archives of Ophthalmology, vol. 117, no. 5, pp. 609–614, 1999.
[9]
J. M. Quivey, D. H. Char, T. L. Phillips, K. A. Weaver, J. R. Castro, and S. M. Kroll, “High intensity 125-iodine (125I) plaque treatment of uveal melanoma,” International Journal of Radiation Oncology Biology Physics, vol. 26, no. 4, pp. 613–618, 1993.
[10]
C. L. Shields, J. A. Shields, J. Cater et al., “Plaque radiotherapy for uveal melanoma: long-term visual outcome in 1106 consecutive patients,” Archives of Ophthalmology, vol. 118, no. 9, pp. 1219–1228, 2000.
[11]
K. L. Leonard, N. L. Gagne, J. E. Mignano, J. S. Duker, E. A. Bannon, and M. J. Rivard, “A 17-year retrospective study of institutional results for eye plaque brachytherapy of uveal melanoma using 125I, 103Pd, and 131Cs and historical perspective,” Brachytherapy, vol. 10, no. 4, pp. 331–339, 2011.
[12]
A. W. Jensen, I. A. Petersen, R. W. Kline, S. L. Stafford, P. J. Schomberg, and D. M. Robertson, “Radiation complications and tumor control after 125I plaque brachytherapy for ocular melanoma,” International Journal of Radiation Oncology Biology Physics, vol. 63, no. 1, pp. 101–108, 2005.
[13]
R. Jones, E. Gore, W. Mieler et al., “Posttreatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanomas: dose and dose rate effects,” International Journal of Radiation Oncology Biology Physics, vol. 52, no. 4, pp. 989–995, 2002.
[14]
R. Stack, M. Elder, A. Abdelaal, R. Hidajat, and R. Clemett, “New Zealand experience I125 brachytherapy for choroidal melanoma,” Clinical and Experimental Ophthalmology, vol. 33, no. 5, pp. 490–494, 2005.
[15]
J. M. Quivey, J. Augsburger, L. Snelling, and L. W. Brady, “125I plaque therapy for uveal melanoma: analysis of the impact of time and dose factors on local control,” Cancer, vol. 77, no. 11, pp. 2356–2362, 1996.
[16]
M. Diener-West, J. D. Earle, S. L. Fine, et al., “The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings: COMS report no. 18,” Archives of Ophthalmology, vol. 119, no. 7, pp. 969–982, 2001.
[17]
A. D. Singh, M. E. Turell, and A. K. Topham, “Uveal melanoma: trends in incidence, treatment, and survival,” Ophthalmology, vol. 118, no. 9, pp. 1881–1885, 2011.
[18]
D. H. Char, S. Kroll, T. L. Phillips, and J. M. Quivey, “Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy,” Ophthalmology, vol. 109, no. 10, pp. 1850–1854, 2002.
[19]
C. L. Shields, M. Naseripour, J. Cater et al., “Plaque radiotherapy for large posterior uveal melanomas (≥8-mm thick) in 354 consecutive patients,” Ophthalmology, vol. 109, no. 10, pp. 1838–1849, 2002.
[20]
S. Packer, M. Rotman, and P. Salanitro, “Iodine-125 irradiation of choroidal melanoma. Clinical experience,” Ophthalmology, vol. 91, no. 12, pp. 1700–1708, 1984.
[21]
S. Packer, S. Stoller, M. L. Lesser, F. S. Mandel, P. T. Finger, and D. M. Robertson, “Long-term results of iodine 125 irradiation of uveal melanoma,” Ophthalmology, vol. 99, no. 5, pp. 767–774, 1992.
[22]
L. M. Jampol, C. S. Moy, T. G. Murray, et al., “The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: IV. Local treatment failure and enucleation in the first 5 years after brachytherapy. COMS report no. 19,” Ophthalmology, vol. 109, pp. 2197–2206, 2002.
[23]
S. Nag, D. Wang, H. Wu, C. J. Bauer, R. B. Chambers, and F. H. Davidorf, “Custom-made “Nag” eye plaques for 125I brachytherapy,” International Journal of Radiation Oncology Biology Physics, vol. 56, no. 5, pp. 1373–1380, 2003.
[24]
M. S. Sagoo, C. L. Shields, A. Mashayekhi et al., “Plaque radiotherapy for juxtapapillary choroidal melanoma: tumor control in 650 consecutive cases,” Ophthalmology, vol. 118, no. 2, pp. 402–407, 2011.
[25]
J. M. Henk, R. A. F. Whitelocke, A. P. Warrington, and E. M. Bessell, “Radiation dose to the lens and cataract formation,” International Journal of Radiation Oncology Biology Physics, vol. 25, no. 5, pp. 815–820, 1993.
[26]
B. Emami, J. Lyman, A. Brown et al., “Tolerance of normal tissue to therapeutic irradiation,” International Journal of Radiation Oncology Biology Physics, vol. 21, no. 1, pp. 109–122, 1991.
[27]
J. C. Wen, S. C. Oliver, and T. A. McCannel, “Ocular complications following I-125 brachytherapy for choroidal melanoma,” Eye, vol. 23, no. 6, pp. 1254–1268, 2009.
