Does escalation of the apical dose change treatment outcome in beta-radiation of posterior choroidal melanomas with 106Ru plaques?
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.
Hermann
Robert Michael
RM
Department of Radiotherapy and Radiooncology, University of Goettingen, Goettingen, Germany. ro.hermann@t-online.de
Pradier
Olivier
O
Lauritzen
Katharina
K
Ott
Marcel
M
Schmidberger
Heinz
H
Hess
Clemens F
CF
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
D012429:Ruthenium Radioisotopes