The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas.
OBJECTIVE
This article presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with choroidal melanomas.


METHODS
Members of the ABS with expertise in choroidal melanoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report.


RESULTS
Episcleral plaque brachytherapy is a complex procedure and should only be undertaken in specialized medical centers with expertise in this sophisticated treatment program. Recommendations were made for patient selection, techniques, dose rates, and dosages. Most patients with very small uveal melanomas (<2.5 mm height and <10 mm in largest basal dimension) should be observed for tumor growth before treatment. Patients with a clinical diagnosis of medium-sized choroidal melanoma (between 2.5 and 10 mm in height and <16 mm basal diameter) are candidates for episcleral plaques if the patient is otherwise healthy and without metastatic disease. A histopathologic verification is not required. Small melanomas may be candidates if there is documented growth; some patients with large melanomas (>10 mm height or >16 mm basal diameter) may also be candidates. Patients with large tumors or with tumors at peripapillary and macular locations have a poorer visual outcome and lower local control that must be taken into account in the patient decision-making process. Patients with gross extrascleral extension, ring melanoma, and tumor involvement of more than half of the ciliary body are not suitable for plaque therapy. For plaque fabrication, the ophthalmologist must provide the tumor size (including basal diameters and tumor height) and a detailed fundus diagram. The ABS recommends a minimum tumor (125)I dose of 85 Gy at a dose rate of 0.60-1.05 Gy/h using AAPM TG-43 formalism for the calculation of dose. NRC or state licensing guidelines regarding procedures for handling of radioisotopes must be followed.


CONCLUSIONS
Brachytherapy represents an effective means of treating patients with choroidal melanomas. Guidelines are established for the use of brachytherapy in the treatment of choroidal melanomas. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose reporting policies. These guidelines will be modified as further clinical results become available.
Nag
Subir
S
Department of Radiation Oncology, Ohio State University, Columbus, OH 43210, USA. nag.1@osu.edu
Quivey
Jeanne M
JM
Earle
John D
JD
Followill
David
D
Fontanesi
James
J
Finger
Paul T
PT
D001918:Brachytherapy / Q000592:standards*; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D015353:Eye Enucleation; D005544:Forecasting; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D010165:Palladium / Q000627:therapeutic use; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D012429:Ruthenium Radioisotopes / Q000627:therapeutic use; D014604:Uveal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery
D007457:Iodine Radioisotopes; D011868:Radioisotopes; D012429:Ruthenium Radioisotopes; D010165:Palladium