Ruthenium-106 brachytherapy and central uveal melanoma

Uveal melanoma (UM) is the most common primary ocular malignancy. The size and location of the tumor are decisive for brachytherapy with the β-emitting ruthenium-106 (Ru-106) plaque. The treatment of juxtapapillary and juxtafoveolar UM may be challenging because of the proximity or involvement of the macula and optic nerve and high recurrence rates.

Central UMs were defined as lesions up to 5 mm off the optic disc or fovea radius of 5 mm. Between January 2011 and July 2020, we treated 56 patients with Ru-106-brachytherapy. The clinical outcomes for recurrence, visual acuity, and radiation-related toxicity were assessed. The follow-up was 66 (6-136) months.

Of the 56 patients (56 eyes), 8 (14%) suffered from local recurrence. Six relapsing UM in 19 (32%) patients were located close to the optic disc, and two patients had UM close to the macula (2/37, 5%) (p > 0.05). The overall eye-preservation rate was 89%. The pretreatment visual acuity (VA) was 0.45 and reduced to 0.26 after brachytherapy. Radiation retinopathy or optic neuropathy was detected in 7 (13%) patients and radiation maculopathy in 10 (17.9%). Six patients (11%) underwent enucleation for recurrence or radiation-induced ophthalmopathy.

Central UMs are challenging to treat. UMs should be categorized as lesions laterally or medially to the fovea because of different long-term control rates. Localization near the optic disc requires thoughtful management.