Iodine 125 plaque brachytherapy versus transscleral tumor resection in the treatment of large uveal melanomas.
OBJECTIVE
To compare iodine 125 ((125)I) plaque brachytherapy with transscleral tumor resection (TTR) of large uveal melanomas.


METHODS
Retrospective, nonrandomized, comparative, interventional study.


METHODS
Two hundred thirty-seven patients with large uveal melanomas.


METHODS
One hundred fifty-two uveal melanoma patients were treated with (125)I brachytherapy and 85 patients were treated with TTR. Patients were matched according to age, tumor size, and tumor location. Eighteen patients treated with (125)I brachytherapy and 36 patients treated with TTR were eligible for the matched group comparison. The mean patient age was 40.5 years, mean tumor height was 9.4 mm, and mean largest tumor diameter was 14.5 mm. The mean distance of the posterior tumor margin to the optic disc was 9.9 mm and to the fovea was 9.4 mm. The mean follow-up was 27.1 months.


METHODS
Final visual acuity, incidence of secondary glaucoma, secondary enucleation, and metastatic rates.


RESULTS
Visual acuity of 20/200 or better was retained in 61.1% of patients after TTR and 5.6% of patients after (125)I brachytherapy (P < 0.0009). The incidence of secondary glaucoma was higher after (125)I brachytherapy (33.3%) than after TTR (5.6%; P = 0.03). No difference was found with respect to eye retention (P = 0.3) and mortality rates (P = 0.9).


CONCLUSIONS
Patients with large melanomas eligible for TTR retain a better visual function and have a lower incidence of secondary glaucoma than those treated by (125)I brachytherapy.
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D015353:Eye Enucleation / Q000706:statistics & numerical data; D005901:Glaucoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008545:Melanoma / Q000150:complications / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D019233:Retreatment; D012189:Retrospective Studies; D012590:Sclera; D014604:Uveal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000532:radiotherapy* / Q000601:surgery*; D014792:Visual Acuity
D007457:Iodine Radioisotopes