Ruthenium brachytherapy for uveal melanoma, 1979-2003: survival and functional outcomes in the Swedish population.

PURPOSE

To evaluate observed and relative survival rates, enucleation rates, and visual outcome after ruthenium 106 brachytherapy for uveal melanoma.

DESIGN

Retrospective cases series from the Swedish national referral center.

PARTICIPANTS

Five hundred seventy-nine patients (579 eyes) with choroidal or ciliary body melanomas, including 55 tumors more than 7 mm in height, treated with ruthenium episcleral plaques from January, 1979, through April, 2003.

METHODS

Clinical and radiotherapy data were extracted from a dedicated database, and survival status was determined through population registries. Tumor size was classified according to the Collaborative Ocular Melanoma Study criteria. The 5- and 10-year relative survival rates were estimated, and univariate and multivariate regression models were constructed for predictive factors on observed survival, enucleation, and visual deterioration.

MAIN OUTCOME MEASURES

Observed and relative survival rate, proportion of secondary enucleation, deterioration of visual acuity to less than 0.5, respectively, to 0.1 or worse.

RESULTS

Tumors were classified as small in 10.5%, medium in 78.4%, and large in 9.2% of patients. The 5- and 10-year observed overall survival rates were 83.3% and 71.5%, respectively, and the corresponding relative rates were 95.5% and 94%, respectively. Factors predicting survival were tumor diameter, patient age, and secondary enucleation. One hundred six patients (18%) underwent enucleation up to 14 years after plaque treatment. The only predictive factor for enucleation was tumor size. At 5 years, 31% of the patients retained 0.5 visual acuity or better, and 49% retained better than 0.1 visual acuity. Predictive factors for visual deterioration were visual acuity and distance from posterior tumor border to the foveola.

CONCLUSIONS

After ruthenium brachytherapy for uveal melanoma, the survival rates and visual outcomes in this population-based investigation were similar to previously published results. The eye was retained in 81.7% of patients. Careful patient selection (presently we only treat melanomas 7 mm or smaller in height) and life-long monitoring for recurrences is warranted.