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Am J Ophthalmol. 2018 Apr;188:60-69. doi: 10.1016/j.ajo.2018.01.025. Epub 2018 Feb 1.

A 12-Year Study of Slotted Palladium-103 Plaque Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve.

Author information

1
The New York Eye Cancer Center, New York, New York.
2
The New York Eye Cancer Center, New York, New York. Electronic address: pfinger@eyecancer.com.

Abstract

PURPOSE:

To present our 12-year experience with low-energy-photon, slotted eye plaque radiation therapy.

DESIGN:

Retrospective interventional case series.

METHODS:

Setting: The New York Eye Cancer Center.

STUDY POPULATION:

Fifty-two consecutive patients with uveal melanomas near, touching, or surrounding the optic disc.

INTERVENTION:

Slotted eye plaque radiation therapy.

MAIN OUTCOME MEASURES:

Change in visual acuity, local tumor control, radiation side effects, eye salvage, and systemic metastases.

RESULTS:

Tumors were peripapillary within 1.5 mm of the optic disc (n = 8, 15%), juxtapapillary touching ≤180 degrees (n = 23, 44%), or circumpapillary >180 degrees and encircling the disc (n = 21, 41%). Mean follow-up was 47 months (median 34 months, range 6-146 months). Radiation induced a mean 41.2% reduction in tumor thickness. Life table analysis showed that 69% of patients retained their visual acuities ≥ 20/40 and had a vision loss-free survival 84 months after treatment. Also, 90% of patients retained their visual acuity between 20/50 and 20/200 and had a vision loss-free survival 36 months after treatment. Slotted plaque brachytherapy was associated with 4% secondary cataract, 11% neovascular glaucoma, and no dry eye or eyelash loss. Local tumor control (no recurrence) was achieved in 98.1% of patients. Life table analysis showed an overall enucleation-free survival of 93% and metastasis-free survival of 94%.

CONCLUSIONS:

Slotted plaque radiation therapy provided a normalized plaque-tumor position, such that the entire choroidal melanoma plus a 2- to 3-mm free margin of normal-appearing tissue was included in the targeted zone. At 12 years, slotted plaque radiation therapy resulted in high rates of local tumor control and vision and eye retention.

PMID:
29409899
DOI:
10.1016/j.ajo.2018.01.025
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