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Original Investigation | Clinical Sciences

Palladium-103 Plaque Radiation Therapy for American Joint Committee on Cancer T3- and T4-Staged Choroidal Melanomas

Ekaterina Semenova, MD1,2; Paul T. Finger, MD1,2,3,4
[+] Author Affiliations
1The New York Eye Cancer Center, New York City, New York
2The New York Eye and Ear Infirmary, New York City, New York
3Beth Israel Comprehensive Cancer Center, New York City, New York
4New York University School of Medicine, New York City, New York
JAMA Ophthalmol. 2014;132(2):205-213. doi:10.1001/jamaophthalmol.2013.5677.
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Importance  Patients with larger choroidal melanomas are being treated with plaque radiation therapy.

Objective  To report the methods and results of palladium-103 brachytherapy for American Joint Committee on Cancer, 7th edition, T3- and T4-sized choroidal melanomas.

Design, Setting, and Participants  A retrospective analysis of the results of a clinical case series over a 10-year period of 47 consecutive patients with uveal melanoma. The patients were treated at The New York Eye Cancer Center, Beth Israel Comprehensive Cancer Center, or The New York Eye and Ear Infirmary between 2002 and 2012 and had a minimum follow-up of 6 months. Tumors had a mean preoperative apical tumor height of 8.6 mm and a mean largest basal diameter of 15.8 mm.

Main Outcomes and Measures  We analyzed, but were not limited to, data on the methods of radiation therapy, local tumor control, adverse effects, vision retention, and metastatic rate.

Results  All patients completed therapy and received the prescribed tumor apex dose. At a median of 47 months (range, 6-125 months), the rate of local control was 91% and the rate of eye retention was 89%. The most common long-term brachytherapy-related complication was radiation maculopathy (66% of patients), followed by radiation optic neuropathy (51% of patients). One or both of these complications were diagnosed at a mean time of 16 months (range, 2-36 months) after brachytherapy. Secondary cataract developed in 36% of patients. Glaucoma developed in 17% of patients and resulted in enucleation in 4% of patients. The mean pretreatment visual acuity was 20/50 (range, 20/12.5 to hand motions), which evolved to a mean visual acuity of 20/100 (range, 20/20 to no light perception). Overall, 25 of 47 patients (53%) maintained 20/200 or better vision. Metastatic melanoma developed in 32% of patients.

Conclusions and Relevance  Palladium-103 ophthalmic plaque radiation therapy can be used as an eye- and vision-preserving treatment for relatively large American Joint Committee on Cancer T3- or T4-sized choroidal melanomas.

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Figure 1.
The 7th edition American Joint Committee on Cancer Uveal Melanoma Staging Graph
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Figure 2.
Fundus Photographs and Fluorescein Angiography

Pretreatment fundus photography reveals a T3-sized posterior choroidal melanoma (A and B). Thirty-five months after palladium-103 brachytherapy, fundus photography (C) and fluorescein angiography (D) reveal that there is no radiation maculopathy or optic neuropathy; visual acuity is 20/32.

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Figure 3.
Kaplan-Meier Estimates

These Kaplan-Meier estimates show the time to the development of radiation maculopathy, radiation optic neuropathy, radiation-related glaucoma, and vitreous hemorrhage (A) and disease-specific survival (B) for patients with American Joint Committee on Cancer T3- and T4-staged uveal melanomas.

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Figure 4.
Tumor Thickness Regression After Palladium-103 Plaque Brachytherapy

The error bars indicate 95% CIs.

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