Custom-made "Nag" eye plaques for 125I brachytherapy.
OBJECTIVE
To report our experience in treating medium-size ocular melanomas with custom-made "Nag" eye plaques.


METHODS
Seventy-eight patients with medium-size ocular melanomas were treated with plaques of 0.6-mm-thick, 18k gold with a radius of curvature of 12 mm to conform to the curvature of the eyeball. These plaques were custom-made in various sizes and shapes to encompass the base of the tumor and a 1-mm margin on all sides. Apertures in three wings of these plaques allowed sutures to be easily placed to hold the plaques onto the sclera. A dose of 100 Gy (before TG-43) or 85 Gy (after TG-43) was delivered with (125)I in 4 days. The dose was prescribed to the periphery of tumor at the level of tumor apex to ensure that the entire tumor volume received at least this dose.


RESULTS
The median follow-up was 49 months (range 8-112 months). The progression-free survival (Kaplan-Meier method), overall survival, and disease-specific survival at 5 years were 93%, 86%, and 97%, respectively. Fifty of 78 (64%) patients retained useful visual acuity (20/200 or better). Thirty-one of 78 (40%) patients developed retinopathy or papillopathy. In the subgroup of 22 patients with tumor distance < or =2 mm from optic disc or macula, 12 patients (54%) developed retinopathy or papillopathy. Only 7 of these patients (32%) had useful vision (20/200 or better). Short distance to optic disc or macula was associated with significantly poor visual acuity and moderate to severe retinopathy or papillopathy (ANOVA, p = 0.004 and p = 0.002, respectively).


CONCLUSIONS
Our experience suggests that custom-made Nag plaque brachytherapy can control medium-size choroidal melanoma and that a 1-mm, rather than the standard 2-mm, minimum margin is sufficient when this plaque and prescription methods are used. Patients with tumors close (< or =2 mm) to optic disc or macula have a significantly poorer visual outcome.
Nag
Subir
S
Division of Radiation Oncology, The Ohio State University Medical Center and The Arthur James Cancer Hospital, Columbus, OH 43210, USA.
Wang
Dian
D
Wu
Hong
H
Bauer
Constance J
CJ
Chambers
Robert B
RB
Davidorf
Frederick H
FH
D001918:Brachytherapy / Q000295:instrumentation*; D002830:Choroid Neoplasms / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*
D007457:Iodine Radioisotopes