Early Outcomes of Uveal Melanomas Treated Using Modern Biopsy Techniques and Intraoperative Ultrasound Guidance: Local Tumor Control and Systemic Outcomes

Publication date: Available online 7 January 2017
Source:Practical Radiation Oncology
Author(s): Anne W. Tann, Bin S. Teh, Sarah B. Scarboro, Gary D. Lewis, Maria E. Bretana, Porshea C. Croft, Yuval Raizen, E. Brian Butler, Ryan S. Kim, Patricia Chevez-Barrios, Amy C. Schefler
PurposeTo report early outcomes of patients with uveal melanoma treated with Eye Physics iodine-125 episcleral plaque therapy using modern biopsy techniques and intraoperative ultrasound guidance at our institution.Methods and MaterialsA retrospective chart review was conducted for 48 consecutive uveal melanoma patients who were treated with Eye Physics plaque brachytherapy performed by one ocular oncologist. All patients underwent intraoperative ultrasound for image guidance of plaque placement. A dose of 85Gy was prescribed to the apical height of the tumor or 5mm from the inner sclera, whichever was greater. Forty-five patients underwent biopsy. Visual acuity, complication data, and recurrence rates were recorded.ResultsMedian age at presentation was 63.0years (range 19–86years). Median follow-up was 21.6months. Median tumor apical height was 3.3mm (range 1.8–11.5mm). Median dose at apex for tumor height>5mm was 85.0Gy and 142.5Gy for tumor height≤5mm. Mean percent decrease in tumor height from baseline at 12, 24, and 36months was 39.6%, 51.8%, and 53.8%, respectively. At 24months, 19/23 (82.6%) patients maintained vision within 3 lines of baseline visual acuity. Twelve patients developed radiation retinopathy; 6 of whom were treated with anti-VEGF therapy in the context of a clinical trial. No patients to date have local failure. Three patients are alive with confirmed hepatic metastases.ConclusionWe reported 0% early local failure rate and steady reduction in tumor height in 48 patients with uveal melanoma, ranging from small to large size, who were treated with Eye Physics iodine-125 episcleral plaque therapy using intraoperative ultrasound guidance. This promising result emphasizes the importance of image guided brachytherapy (IGB) with intraoperative ultrasound at the time of plaque placement.



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