New Zealand experience of I¹²⁵ brachytherapy for choroidal melanoma

Authors: Stack, Rebecca¹; Elder, Mark; Abdelaal, Al²; Hidajat, Rudy; Clemett, Richard¹

Source: Clinical & Experimental Ophthalmology, Volume 33, Number 5, October 2005 , pp. 490-494(5)

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Abstract:

Purpose:

To examine patient survival, visual function and complications in all patients with choroidal melanoma treated with I¹²⁵ brachytherapy between 1995 and 2003 at the authors’ institution. To compare the results from their institution with those from international series. Methods:

Data were collected on 92 consecutive patients. Dosimetry was calculated for the lens, fovea, optic nerve and tumour apex. Follow-up status of each patient domiciled outside the treatment centre was analysed from a postal questionnaire. Results:

Average pretreatment tumour dimensions were 3.9 mm (thickness) and 15.2 mm (diameter). Complete follow-up data were available on 92% of patients. Regression of tumour occurred in 88% of cases. Five enucleations were performed. There were five melanoma-related deaths. Visual acuity remained >6/12 in 35% of patients and >6/60 in 51% of patients. The most frequently observed complication was radiation retinopathy (maculopathy 23%, peripheral retinopathy 17%). Radiation cataract was seen in 11% and optic neuropathy in 10%. Dose of more than 90 Gy to the macula gave a 63% chance of developing maculopathy (P < 0.01). A tumour larger than 4 mm significantly increased the risk of developing radiation maculopathy (P = 0.003). Development of radiation cataract was dose-related; >25 Gy to the lens gave a 44% risk of cataract development (P < 0.001). For tumours less than 4 mm from the disc margin there was a 50% risk of optic neuropathy (P < 0.001). Conclusions:

Patient outcomes following brachytherapy were excellent with a high percentage of patients retaining mobility vision. Development of complications was related to the tumour location and dose to non-tumour structures.

Keywords: brachytherapy; choroidal melanoma; iodine; plaque

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1442-9071.2005.01067.x

Affiliations: 1: Ophthalmology Department, 2: Oncology Department and

Publication date: 2005-10-01