title: Plaque radiotherapy for choroidal melanoma encircling the optic disc (circumpapillary choroidal melanoma).
abstract: OBJECTIVE
  To report results of plaque radiotherapy for choroidal melanoma that completely encircles the optic disc (circumpapillary melanoma).
  
  
  METHODS
  Retrospective medical record review over a 31-year period of 37 consecutive patients. The main outcome measures were treatment complications, long-term visual acuity, enucleation, tumor recurrence, metastasis, and death.
  
  
  RESULTS
  The median patient age at treatment was 69 years (range, 20-86 years). The presenting complaint was visual loss in 19 eyes (51%), photopsia in 5 (14%), and visual field loss in 3 (8%). All tumors touched and encircled the optic disc for 360 degrees . The quadrantic location of the main tumor epicenter was superior in 8 eyes (22%), nasal in 10 (27%), inferior in 9 (24%), and temporal in 10 (27%). The median tumor basal diameter was 11 mm (range, 4.8-20 mm) and median tumor thickness was 3.6 mm (range, 1.8-14.8 mm). The optic disc was obscured to some extent by overhanging tumor in 19 cases (52%). The most commonly used isotope for plaque radiotherapy was iodine 125 (n = 34 cases; 92%), and a notched plaque design was used in 34 cases (92%). Planned adjunctive treatment included transpupillary thermotherapy in 17 cases (49%) and argon laser photocoagulation in 6 of 35 cases (17%) with follow-up. Of the 28 eyes with more than 5 months' follow-up (mean, 52 months; median, 46 months; range, 5-234 months), treatment complications included nonproliferative and proliferative retinopathy in 11 (39%) and 7 eyes (25%); maculopathy in 7 (25%); papillopathy in 9 eyes (32%); neovascular glaucoma in 5 (18%); and vitreous hemorrhage in 13 (46%). Pars plana vitrectomy was required in only 2 of 13 eyes (15%) with persistent vitreous hemorrhage. Long-term visual acuity of 20/200 or worse was observed in 13 eyes (62%), and 12 eyes (57%) lost more than 5 Snellen visual acuity lines, excluding 7 cases (25%) in which enucleation was necessary. Recurrence was noted in 4 cases (14%), of which 3 were treated with enucleation and 1 with transpupillary thermotherapy. Systemic metastasis occurred in 1 patient (4%) and there were no melanoma-specific deaths during the study period.
  
  
  CONCLUSIONS
  Custom-designed plaque radiotherapy is a potential treatment for selected patients with circumpapillary choroidal melanoma. We found satisfactory local tumor control, and globe retention was achieved in 75% of eyes with more than 5 months' follow-up.
authors.affiliation: Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sagoo
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Arman
authors.initials: A
authors.lastname: Mashayekhi
authors.forename: Jorge
authors.initials: J
authors.lastname: Freire
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Emrich
authors.forename: Jay
authors.initials: J
authors.lastname: Reiff
authors.forename: Lydia
authors.initials: L
authors.lastname: Komarnicky
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002830:Choroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D003037:Cobalt Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D017075:Laser Coagulation; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014792:Visual Acuity; D014821:Vitrectomy
chemical_list: D003037:Cobalt Radioisotopes; D007457:Iodine Radioisotopes