title: Intraoperative ultrasonography-guided positioning of iodine 125 plaque brachytherapy in the treatment of choroidal melanoma.
abstract: OBJECTIVE
  To report intraoperative ultrasonography-guided positioning of iodine 125 (I(125)) plaques for brachytherapy of choroidal melanoma as a quality improvement measure.
  
  
  METHODS
  Retrospective, single-center, consecutive case-cohort study.
  
  
  METHODS
  One hundred fifty consecutive patients with choroidal melanoma.
  
  
  METHODS
  Patients with choroidal melanoma who were treated with I(125) plaque brachytherapy from January 2007 through January 2011 with at least 6 months of clinical follow-up were included.
  
  
  METHODS
  Patient and tumor characteristics at diagnosis were tabulated. The need for plaque repositioning if intraoperative ultrasonography showed the plaque to be either not centered on the tumor or if there was less than 1.0 mm of plaque margin beyond the tumor border was recorded. The rate of local treatment failure and occurrence of distant metastasis were determined.
  
  
  RESULTS
  The average interval from surgery to last follow-up was 21.5 months. Fifty-four (36%) of 150 patients required plaque repositioning. Of tumors located in the macula, equator, and periphery, 15 (36.6%), 26 (36.6%), and 13 (34.2%) required repositioning. There was no case of local treatment failure during a mean follow-up of 21.5 months (range, 6-48 months). Clinical evidence of choroidal melanoma metastasis developed in 9 patients. The cumulative 2-year Kaplan-Meier rate of local treatment failure in the cohort was statistically lower compared with the Collaborative Ocular Melanoma Study, which did not require ultrasonography-guided plaque positioning.
  
  
  CONCLUSIONS
  Intraoperative ultrasonography identified the need to reposition I(125) plaques to achieve centration and plaque margin (>1.0 mm) beyond the tumor border in 36% of eyes. Neither tumor size nor tumor location correlated with the need to reposition the plaque. There was no case of local treatment failure during follow-up in this series. Correct plaque position is an essential component of quality outcomes in brachytherapy. Intraoperative ultrasonography reduces geographic errors in placement in eye plaque therapy and may help to reduce local treatment failure in choroidal melanoma.
authors.affiliation: Department of Ophthalmology, University of California, Los Angeles, CA, USA.
authors.forename: Melinda Y
authors.initials: MY
authors.lastname: Chang
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
authors.forename: D Jeffrey
authors.initials: DJ
authors.lastname: Demanes
authors.forename: Min
authors.initials: M
authors.lastname: Leu
authors.forename: Nzhde
authors.initials: N
authors.lastname: Agazaryan
authors.forename: James
authors.initials: J
authors.lastname: Lamb
authors.forename: Joel N
authors.initials: JN
authors.lastname: Moral
authors.forename: Robert
authors.initials: R
authors.lastname: Almanzor
authors.forename: Tara A
authors.initials: TA
authors.lastname: McCannel
mesh_terms: D001918:Brachytherapy; D016022:Case-Control Studies; D002830:Choroid Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012086:Reoperation; D012189:Retrospective Studies; D014463:Ultrasonography
chemical_list: D007457:Iodine Radioisotopes