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Radiation complications and tumor control after 125I plaque brachytherapy for ocular melanoma
Ashley W Jensen1, Ivy A Petersen, Robert W Kline
1Department of Radiation Oncology, Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Purpose:
To determine the outcome of 125I plaque brachytherapy at our institution and identify the risk factors associated with the development of radiation complications, tumor recurrence, and metastasis.
Patients And Methods:
From 1986 to 2000, 156 patients underwent 125I episcleral plaque (COMS design) application for the treatment of ocular melanoma. Chart analysis of follow-up ophthalmologic appointments assessed the incidence of ocular side effects after therapy. Statistical analysis assessed outcomes and significant influencing factors.
Results:
With a median follow-up of 6.2 years, the 5-year overall survival was 83%. The 5-year disease-specific survival was 91%. Initial local control at 5 years was 92%, with 100% ultimate local control after secondary therapy that included 9 enucleations. The risk of metastasis was 10% at 5 years and 27% at 10 years. Vision stayed the same or improved in 25% of patients, and 44% of patients maintained visual acuity better than 20/200. Thirteen percent of patients experienced chronic pain or discomfort in the treated eye. Dose rates to the tumor apex greater than 90 to 100 cGy/h were associated with increased systemic control but worse radiation toxicity.
Conclusion:
Patients in our series experienced excellent local tumor control. Higher dose rates to the tumor apex were associated with reduced rates of distant metastases but worse ocular function.
