title: Extrascleral extension of choroidal melanoma: post-enucleation high-dose-rate interstitial brachytherapy of the orbit.
abstract: OBJECTIVE
  To investigate if orbital extension of uveal melanoma can be treated with high-dose-rate (HDR) brachytherapy.
  
  
  METHODS
  This study is a retrospective analysis of the results of a clinical case series was performed on 10 patients. Each underwent primary enucleation for uveal melanoma, was discovered to have orbital extension, and consented for HDR brachytherapy. By American Joint Committee on Cancer (AJCC) initial tumor grading, there was one each (T1c, T2c, T2d, and T3d, three T4c, and two T4d-staged uveal melanomas. One was AJCC-staged R2 due to orbital recurrence presenting 16 months after enucleation. (192)Ir HDR brachytherapy involved transcutaneous circumferential orbital incisions allowing for evenly spaced brachytherapy catheters into the orbit. A target dose of 32.85 Gy (range, 32.85-34 Gy) was delivered in 9-10 twice-daily fractions (range, 3.4-3.65 Gy per fraction) over 5 consecutive days. Data analysis included but was not limited to radiation therapy methods, local tumor control, side effects, and metastatic rate.
  
  
  RESULTS
  In the 9 patients who tolerated treatment, there has been no orbital recurrence at a median follow-up of 18 months (range, 1-62 months). Four patients died of metastatic disease (one presented with a treated solitary liver metastasis before brachytherapy). There was no significant eyelash or eyebrow loss. There was no radiation-induced eyelid erythema, orbital infection, or contracted sockets. All orbits accepted and maintained ocular prostheses.
  
  
  CONCLUSIONS
  Brachytherapy was used as an alternative to external beam radiation treatment for postenucleation orbital melanoma. This series reports complete local control, few side effects, and excellent cosmetic results.
authors.affiliation: Departments of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, 115 East 61st Street, New York, NY 10065; Department of Radiation Oncology, Beth Israel Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011; Department of Ophthalmology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003. Electronic address: pfinger@eyecancer.com.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Finger
authors.affiliation: Department of Radiation Oncology, Beth Israel Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011; Department of Ophthalmology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Tena
authors.affiliation: Departments of Ocular Tumor, Orbital Disease and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, 115 East 61st Street, New York, NY 10065; Department of Ophthalmology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Semenova
authors.affiliation: Department of Radiation Oncology, Beth Israel Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011.
authors.forename: Paul
authors.initials: P
authors.lastname: Aridgides
authors.affiliation: Department of Radiation Oncology, Beth Israel Comprehensive Cancer Center, 325 West 15th Street, New York, NY 10011; Department of Ophthalmology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Choi
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D015353:Eye Enucleation; D005137:Eye, Artificial; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000532:radiotherapy*; D009918:Orbital Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000473:pathology / Q000601:surgery*; D000098943:Uveal Melanoma
keywords: Brachytherapy; Extrascleral; Melanoma; Orbit; Radiation