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

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.