title: Custom-designed plaque radiotherapy for nonresectable iris melanoma in 38 patients: tumor control and ocular complications.
abstract: OBJECTIVE
  To evaluate plaque radiotherapy for iris melanoma.
  
  
  METHODS
  Prospective noncomparative interventional case series.
  
  
  METHODS
  For 38 patients, custom-designed plaque radiotherapy using iodine 125 isotope was applied overlying the cornea with a tumor apex dose of 80 Gy. The main outcome measures were tumor control and ocular complications using Kaplan-Meier estimates and Cox proportional hazards regression analysis.
  
  
  RESULTS
  In all cases, the melanoma was nonresectable owing to large or discohesive tumor. The tumor configuration was nodular in 24 cases (63%) and flat (diffuse) in 14 (37%). The mean tumor basal diameter was 9 mm (range 4 to 13 mm). Solid tumor extended into the anterior chamber angle in 36 eyes (95%). Tumor seeds were noted on the iris stroma for a mean of 7 clock hours and in the anterior chamber angle for a mean of 4 clock hours. Five-year follow up revealed tumor metastasis in 0% and tumor recurrence in 8% of patients. Visual acuity of 20/200 or worse was found in 16% at 5 years. Radiation-related complications at 5 years included corneal epitheliopathy (9%), cataract (70%), and neovascular glaucoma (8%). No patients developed corneal necrosis, scleral necrosis, retinopathy, or papillopathy. After treatment, the combined incidence of tumor-related and radiation-related elevated intraocular pressure at 5 years was 33%. Enucleation was necessary in 13% at 5 years, for tumor recurrence (n = 3) and patient preference (n = 1).
  
  
  CONCLUSIONS
  Plaque radiotherapy is a useful alternative to enucleation for eyes with nonresectable iris melanoma. Tumor control is 92% at 5 years, but related complications, especially cataract and elevated intraocular pressure, should be anticipated.
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Masood
authors.initials: M
authors.lastname: Naseripour
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
authors.forename: Jorge
authors.initials: J
authors.lastname: Freire
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Cater
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000528:radiation effects; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods*; D002386:Cataract / Q000209:etiology; D002648:Child; D018572:Disease-Free Survival; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000528:radiation effects; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D015811:Iris Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D007908:Lens, Crystalline / Q000528:radiation effects; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology
chemical_list: D007457:Iodine Radioisotopes