title: Episcleral brachytherapy of uveal melanoma: role of intraoperative echographic confirmation.
abstract: To compare the rates of tumour recurrence following episcleral brachytherapy for uveal melanoma before and after implementation of intraoperative echographic confirmation of plaque placement.
  
  
  
  All patients with primary single ciliary body or choroidal melanoma treated with iodine-125 or ruthenium-106 plaque brachytherapy between 1 January 2004 and 30 December 2013 were included. Exclusion criteria were patients with previous radiation treatment and patients who received adjuvant transpupillary thermotherapy. Since February 2007, intraoperative echographic confirmation was initiated to ensure that the plaque was centred on the tumour base and/or all tumour margins were covered by the plaque.
  
  
  
  252 patients were included in the study. Local tumour control after primary brachytherapy was achieved in 242/252 (96.0%). Of the 10 patients with treatment failure, 8 patients had local recurrence and 2 patients had failure to response. With the incorporation of the intraoperative echographic confirmation for plaque positioning the treatment failure rate decreased from 9.3% (5/54 patients) to 1.5% (3/198 patients). Continuous and categorical univariable predictors of recurrence were analysed for statistical significance. The only statistically significant variable was the intraoperative echographic confirmation (HR: 0.16; p=0.032) for recurrence within the first 24 months.
  
  
  
  Intraoperative echographic confirmation of plaque placement during episcleral brachytherapy for choroidal melanoma reduces the risk of early local recurrence.
authors: Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Hassan A
authors: HA
authors: Aziz
authors: Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Yahya A
authors: YA
authors: Al Zahrani
authors: Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: James
authors: J
authors: Bena
authors: Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Brandy
authors: B
authors: Lorek
authors: Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Allan
authors: A
authors: Wilkinson
authors: Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA.
authors: John
authors: J
authors: Suh
authors: Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Arun D
authors: AD
authors: Singh
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D007432:Intraoperative Period; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000628:therapy*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D009887:Ophthalmoscopy; D012189:Retrospective Studies; D012590:Sclera; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D014604:Uveal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D000098943:Uveal Melanoma
keywords: Choroid; Diagnostic tests/Investigation; Retina