Episcleral iridium-192 wire therapy for choroidal melanomas.
OBJECTIVE
To evaluate the effectivity of high-dose episcleral iridium-192 wires in the treatment of choroidal melanoma.


METHODS
In 1983, the Departments of Radiation Oncology and Ophthalmology at the Clínica Puerta de Hierro, Madrid, Spain, initiated a clinical study using removable episcleral iridium-192 wires in the treatment of choroidal melanoma. Sixty-six evaluable patients were treated from January 1983 through July 1992. Two patients had a small sized tumor (3%), 28 had a medium sized tumor (42%), and 36 patients had a large tumor (54%). The mean follow-up was 40 months (6-118 months). The dose to the apex of the tumor ranged from 66 to 97 Gy (mean 76.6 Gy), and the doses at 2 mm depth ranged from 77 to 433 Gy (mean 200 Gy).


RESULTS
Tumor regression or stabilization was observed in 53 of the 66 patients (90%). Visual acuity improved following treatment in 5 out of 54 patients (9%), remaining unchanged in 30 out of 54 (56%), and decreased in 19 out of 54 (35%) patients. The remaining seven patients had undergone enucleation. Late complications have been documented in 20 out of 66 patients (30%), including 6 patients in whom enucleation was required because of radiation-related complications. The probability of survival and survival free of local progression was 93% at 5 years and 79% at 10 years. The probability of retaining the treated eye is 82% after the fifth year posttreatment.


CONCLUSIONS
Treatment of choroidal melanomas with episcleral iridium-192 wires is as effective as treatment with other radioactive applications. We feel that our results using iridium-192 wires are comparable to the other methods. However, we think that our technique is simple to implement, relatively inexpensive, and well tolerated.
Radiation Oncology Department, Universidad Autonoma, Madrid, Spain.
F
F
Valcárcel
S
S
Valverde
H
H
Cárdenes
C
C
Cajigal
A
A
de la Torre
R
R
Magallón
C
C
Regueiro
J L
JL
Encinas
G
G
Aragón
D001918:Brachytherapy / Q000379:methods*; D002830:Choroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D015353:Eye Enucleation; D005500:Follow-Up Studies; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D009362:Neoplasm Metastasis; D011336:Probability; D015996:Survival Rate; D013997:Time Factors; D014792:Visual Acuity
D007496:Iridium Radioisotopes