title: Ruthenium-106 brachytherapy for choroidal melanoma without transpupillary thermotherapy: Similar efficacy with improved visual outcome.
abstract: To evaluate efficacy and toxicity of two different protocols for eye-conserving treatment of patients with small to intermediate-sized choroidal melanomas; the current ruthenium-106 (Ru106) brachytherapy protocol and the preceding protocol of Ru106-brachytherapy with transpupillary thermotherapy (Ru106/TTT).
  
  
  
  Long-term outcomes of 449 consecutive patients, of whom 196 (43.6%) treated using Ru106/TTT and 253 (56.3%) treated using Ru106, were compared in terms of local control, survival, eye preservation and visual outcome.
  
  
  
  Median follow-up was 82.8 months. Patients in the Ru106-group had smaller, less centrally located tumours and better pre-treatment visual acuity (VA). Five-year cumulative incidence of local failure was 11.2% for Ru106/TTT and 5.2% for Ru106, which was not statistically significant after correction for differences in baseline characteristics (hazard ratio for Ru106 = 0.57, p = 0.14). Cumulative incidence of distant metastases was 11.2 versus 6.2%, and cumulative incidence of cause-specific death was 22.4 versus 5.5% for Ru106/TTT and Ru106 respectively. Enucleation was performed in 9.2 versus 4.0% for Ru106/TTT versus Ru106; 5.1 versus 3.2% for local failure and 2.6 versus 0.8% for complications. At one year of follow-up, significantly more patients had lost useful vision (VA < 0.33) in the Ru106/TTT-group than in the Ru106-group (50.0 versus 24.5%). After two and three years, the differences decreased (54.6 versus 34.0% and 61.7 versus 45.8%, respectively) and lost statistical significance.
  
  
  
  Both the current Ru106 and the preceding Ru106/TTT-protocols provided excellent tumour control, cosmetic and functional eye preservation and vital prognosis. The Ru106-protocol yielded prolonged preservation of VA and should be regarded the current standard of treatment.
authors.affiliation: Department of Ophthalmology and Melanoma Center, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marina
authors.initials: M
authors.lastname: Marinkovic
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nanda
authors.initials: N
authors.lastname: Horeweg
authors.affiliation: Department of Biostatistics, Leiden University Medical Center, Leiden, The Netherlands; Mathematical Institute Leiden University, Leiden, The Netherlands.
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Femke P
authors.initials: FP
authors.lastname: Peters
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Linda W
authors.initials: LW
authors.lastname: Sommers
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Mirjam S
authors.initials: MS
authors.lastname: Laman
authors.affiliation: Department of Ophthalmology and Melanoma Center, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jaco C
authors.initials: JC
authors.lastname: Bleeker
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Ketelaars
authors.affiliation: Department of Ophthalmology and Melanoma Center, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Gre P M
authors.initials: GP
authors.lastname: Luyten
authors.affiliation: Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: c.l.creutzberg@lumc.nl.
authors.forename: Carien L
authors.initials: CL
authors.lastname: Creutzberg
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002830:Choroid Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004172:Diplopia / Q000453:epidemiology / Q000209:etiology; D015353:Eye Enucleation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D012164:Retinal Diseases / Q000453:epidemiology / Q000209:etiology; D012429:Ruthenium Radioisotopes / Q000627:therapeutic use*; D016896:Treatment Outcome; D047368:Tumor Burden; D014605:Uveitis / Q000453:epidemiology / Q000209:etiology; D014792:Visual Acuity
chemical_list: D012429:Ruthenium Radioisotopes
keywords: Brachytherapy; Choroid neoplasms; Melanoma; Ruthenium radioisotopes; Transpupillary thermotherapy; Treatment outcome