[Brachytherapy in choroidal melanoma]

Brachyterapy in the management of intraocular tumors was introduced in the Department of Ophthalmology in Cracow in the late sixties, soon after it was applied by Stallard. For many years, similar to other oncological centers, we used 60Co and in 1994 we started with 106Ru and at the end of 1997 with 125J. The aim of this paper is to present our experiences with 106Ru and 125J brachytheray in posterior uveal melanoma.

Our studies comprised 164 patients with choroidal melanoma, treated in the years 1995-1997 with 106Ru and 19 patients treated between December 1997 nad April 1998 with 125J plaque brachytherapy. There were 93 women and 90 men, aged 18-86. Tumor thickness was beneath 6 mm in 85 cases, 6-9 mm in 63 and above 9 mm in 35. In 121 eyes anterior margin of the tumor was located in equatorial region or posterior to it, 62 the tumor situated anterior to the equator attached to the ciliary body. The usual dosage was 60-100 Gy to the tumor apex; in 33 eyes transpupillary thermotherapy (TTT) with diode laser was added. The follow-up ranges from 3 months to 3 years after 106Ru plaque brachytherapy and 1-3 months after 125J.

Criteria of the treatment efficacy were decrease of tumor thickness at least 10%, increase of its density and vessel obliterations. Among 164 patients treated with 106Ru improvement was achieved in 84 (51.2%) of cases, stabilization in 50 (30.5%) and negative results in 30 (18.3%). Enucleation was performed in 16 (9.7%) cases. Among 19 patients treated with 125J preliminary evaluation indicates positive reaction for treatment in 14 cases.

Our studies confirm the opinion that brachytherapy is a method of choice in the management of many cases of posterior uveal melanoma. There are significant relationships between the results of treatment and the size of tumor and its location. The adequate choice of the kind of radioactive isotope in the plaque is very important.