Outcomes of iodine-125 plaque brachytherapy for uveal melanoma with intraoperative ultrasonography and supplemental transpupillary thermotherapy.
OBJECTIVE
To assess the impact on local tumor control of intraoperative ultrasonographic plaque visualization and selective application of transpupillary thermotherapy (TTT) in the treatment of posterior uveal melanoma with iodine-125 (I-125) episcleral plaque brachytherapy (EPB).


METHODS
Retrospective analysis of 526 patients treated with I-125 EPB for posterior uveal melanoma. Clinical features, dosimetric parameters, TTT treatments, and local tumor control outcomes were recorded. Statistical analysis was performed using Cox proportional hazards and Kaplan-Meier life table method.


RESULTS
The study included 270 men (51%) and 256 women (49%), with a median age of 63 years (mean, 62 years; range, 16-91 years). Median dose to the tumor apex was 94.4 Gy (mean, 97.8; range, 43.9-183.9) and to the tumor base was 257.9 Gy (mean, 275.6; range, 124.2-729.8). Plaque tilt >1 mm away from the sclera at plaque removal was detected in 142 cases (27%). Supplemental TTT was performed in 72 patients (13.7%). One or 2 TTT sessions were required in 71 TTT cases (98.6%). After a median follow-up of 45.9 months (mean, 53.4 months; range, 6-175 months), local tumor recurrence was detected in 19 patients (3.6%). Local tumor recurrence was associated with lower dose to the tumor base (P=.02).


CONCLUSIONS
Ultrasound-guided plaque localization of I-125 EPB is associated with excellent local tumor control. Detection of plaque tilt by ultrasonography at plaque removal allows supplemental TTT to be used in patients at potentially higher risk for local recurrence while sparing the majority of patients who are at low risk. Most patients require only 1 or 2 TTT sessions.
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Shahed N
SN
Badiyan
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri.
Rajesh C
RC
Rao
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Anthony J
AJ
Apicelli
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Sahaja
S
Acharya
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Vivek
V
Verma
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Adam A
AA
Garsa
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Todd
T
DeWees
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Christina K
CK
Speirs
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Jose
J
Garcia-Ramirez
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Jacqueline
J
Esthappan
Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri.
Perry W
PW
Grigsby
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri; Ocular Oncology Service, Department of Ophthalmology, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: JWHarbour@med.miami.edu.
J William
JW
Harbour
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D047368:Tumor Burden; D018084:Ultrasonography, Interventional / Q000379:methods*; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control / Q000532:radiotherapy*; D055815:Young Adult; D000098943:Uveal Melanoma
D007457:Iodine Radioisotopes