title: Does escalation of the apical dose change treatment outcome in beta-radiation of posterior choroidal melanomas with 106Ru plaques?
abstract: OBJECTIVE
  To show the results of treating posterior uveal melanomas with 106Ru plaque beta-ray radiotherapy and to review and discuss the literature concerning the optimal apical dose prescription (100 vs. 160 Gy).
  
  
  METHODS
  Forty-eight patients with uveal melanomas (median height 3.85 mm + 1 mm sclera) were treated with ruthenium plaques. The median apical dose was 120 Gy, the median scleral dose 546 Gy.
  
  
  RESULTS
  After 5.8 years of follow-up, the overall 5-year survival rate was 90%, the disease specific 5-year survival rate was 92% (3 patients alive with metastasis). Six percent received a second ruthenium application, 10% of the eyes had to be enucleated. Local control was achieved in 90% of the patients with conservative therapy alone. Central or paracentral tumors showed 50% of the pretherapeutic vision after 4 years, and 80% of the vision was preserved in those with peripheral tumors. The main side effects were mostly an uncomplicated retinopathy (30%); macular degeneration or scarring led to poor central vision in 30% of cases.
  
  
  CONCLUSIONS
  Brachytherapy with ruthenium applicators is an effective therapy for small- and medium-size posterior uveal melanomas. Our results are comparable to other series. The treatment outcome does not seem to be capable of improvement by increasing the apical dose. An internationally accepted model for defining the dosage in brachytherapy is needed.
authors.affiliation: Department of Radiotherapy and Radiooncology, University of Goettingen, Goettingen, Germany. ro.hermann@t-online.de
authors.forename: Robert Michael
authors.initials: RM
authors.lastname: Hermann
authors.forename: Olivier
authors.initials: O
authors.lastname: Pradier
authors.forename: Katharina
authors.initials: K
authors.lastname: Lauritzen
authors.forename: Marcel
authors.initials: M
authors.lastname: Ott
authors.forename: Heinz
authors.initials: H
authors.lastname: Schmidberger
authors.forename: Clemens F
authors.initials: CF
authors.lastname: Hess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002830:Choroid Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy*; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012429:Ruthenium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate; D014792:Visual Acuity
chemical_list: D012429:Ruthenium Radioisotopes