Visual acuity after Ruthenium(106) brachytherapy of choroidal melanomas.
OBJECTIVE
To report on conservation of visual acuity after Ruthenium(106) (Ru-106) brachytherapy of choroidal melanoma.


METHODS
This study was a noncomparative interventional case series of 458 patients with choroidal melanoma treated at a single center between January 1993 and December 2001. The intervention consisted of Ru-106 brachytherapy delivering minimum scleral and apex doses of 300 Gy and 80 Gy, respectively, using a 15-mm or 20-mm plaque. For discrete, posterior tumors, the plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin. To ensure correct plaque positioning, any overlying extraocular muscles were dis-inserted, and the locations of both tumor and plaque edges were confirmed by transillumination and indentation. The main outcome measures were conservation of vision of 20/40 or better, 20/200 or better, and Counting Fingers or better, according to baseline variables.


RESULTS
The actuarial rate of conservation of 20/40 or better was 55% at 9 years, loss of such vision correlating with posterior tumor extension (p < 0.001), temporal tumor location (p = 0.001), increased tumor height (p = 0.01), and older age (p < 0.01) (Cox multivariate analysis). Similar analyses showed conservation of 20/200 or better in 57% of eyes at 9 years, loss correlating with reduced initial visual acuity (p < 0.001), posterior tumor extension (p < 0.001), and temporal tumor location (p = 0.006). Counting Fingers or better vision was conserved in 83% of patients at 9 years, loss correlating with increased tumor height (p < 0.0001). Local tumor recurrence occurred in 9 patients (actuarial rate, 3% at 9 years).


CONCLUSIONS
Ruthenium(106) brachytherapy of posterior choroidal melanoma achieves good conservation of vision if the tumor does not extend close to the optic nerve or fovea.
Ocular Oncology Service, St. Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, United Kingdom. Bertil@damato.co.uk
Bertil
B
Damato
Imran
I
Patel
Ian R
IR
Campbell
Helen M
HM
Mayles
R Douglas
RD
Errington
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001918:Brachytherapy / Q000379:methods*; D002830:Choroid Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000503:physiopathology / Q000532:radiotherapy*; D008875:Middle Aged; D011446:Prospective Studies; D012429:Ruthenium Radioisotopes / Q000627:therapeutic use*; D014792:Visual Acuity / Q000502:physiology / Q000528:radiation effects*
D012429:Ruthenium Radioisotopes