eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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SCImago Journal & Country Rank

2/2022
vol. 14
 
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abstract:
Original paper

Three-year outcomes of uveal melanoma treated with intra-operative ultrasound-guided iodine-125 brachytherapy using custom-built eye plaques

Andrew J. Wong
1
,
Bin S. Teh
2
,
Brandon T. Nguyen
3
,
Ramiro Pino
2
,
Maria E. Bretana
4
,
Eric H. Bernicker
5
,
Patricia Chevez-Barrios
6
,
E. Brian Butler
2
,
Amy C. Schefler
4

1.
UTMB Radiation Oncology, the University of Texas Medical Branch, Galveston, TX, USA
2.
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
3.
Arizona College of Osteopathic Medicine at Midwestern University, Glendale, AZ, USA
4.
Retina Consultants of Houston, Houston, TX, USA
5.
Dr. Mary and Ron Neal Cancer Center, Houston Methodist Hospital, Houston, TX, USA
6.
Departments of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist Hospital, Houston, TX, USA
J Contemp Brachytherapy 2022; 14, 2: 130–139
Online publish date: 2022/04/11
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Purpose
The aim of this study was to demonstrate that uveal melanoma (UM) treated with eye plaque brachytherapy (EPB) with intra-operative ultrasound (IOUS) guidance results in increased local control.

Material and methods
A retrospective study was conducted among 212 patients with 214 UM tumors treated by iodine-125 EPB with IOUS guidance from 2013 to 2019. 85 Gy was prescribed to tumor apical height or 5 mm from inner sclera, whichever was greater. Lesions were treated to 95% of 85 Gy at 2 mm margin from tumor edge. Local failure (LF), distant metastasis (DM), and radiation-related toxicity were recorded.

Results
Median tumor apical height was 3.3 mm. COMS stage was 90 small (42.1%), 81 medium (37.9%), and 43 large (20.1%). Most patients had gene expression profile (GEP) class available, with 119 (55.6%), 30 (14.0%), 55 (25.7%) cases classified as 1A, 1B, and 2, respectively. Median dose at apex for tumor height > 5 mm and ≤ 5 mm was 85.0 Gy and 120.6 Gy, respectively. Outcomes data for 180 patients with over 12 months follow-up were reported. Mean follow-up was 37.3 months. Rates of LF and DM were 0.0% and 12.2%, respectively. Actuarial estimates of 5-year DM for class 1A, 1B, and 2 tumors were 2.5%, 0.0%, and 57.8%, respectively. 87 patients (48.3%) developed radiation-related toxicities.

Conclusions
The excellent local control rate amongst lesions ranging across all sizes and GEP classes emphasizes the importance of image-guided brachytherapy with IOUS. We report favorable 5-year DM rates compared to established rates. Acceptable rate and severity of radiation-related toxicities were observed.

keywords:

uveal melanoma, plaque brachytherapy, image guidance

 
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