title: Visual acuity, oncologic, and toxicity outcomes with103Pd vs.125I plaque treatment for choroidal melanoma.
abstract: To evaluate outcomes of choroidal melanoma patients treated with125I or103Pd plaque brachytherapy.
  
  
  
  From 1993 to 2012, our institution treated 160 patients with103Pd (56.1%) and 125 patients with125I (43.9%) plaque brachytherapy. Tumor outcomes, visual acuity (VA), and toxicity were compared. Multivariate analyses (MVAs) and propensity score analysis were used to help address differences in baseline characteristics.
  
  
  
  Median followup was longer for125I patients, 52.7 vs. 43.5 months (p < 0.01). At baseline,103Pd patients had lower rates of VA worse than 20/200 (4.4% vs. 16%, p = 0.002), T3-T4 tumors (17.5% vs. 32.8%, p = 0.03), and transpupillary thermotherapy use (3.1% vs. 9.6%, p = 0.001). Both103Pd and125I provided >90% 3-year overall survival and >93% 5-year secondary enucleation-free survival. On MVA, radionuclide was not predictive for tumor outcomes. A higher percentage maintained vision better than 20/40 with103Pd (63% vs. 35%, p = 0.007) at 3 years. MVA demonstrated103Pd radionuclide (odds ratio [OR]: 2.12, p = 0.028) and tumor height ≤5 mm (OR: 2.78, p = 0.017) were associated with VA better than 20/40. Propensity score analysis matched 23125I with 107103Pd patients.103Pd continued to predict better VA at 3 years (OR: 8.10, p = 0.014). On MVA for the development of VA worse than 20/200 or degree of vision loss, radionuclide was not significant. Lower rates of radiation retinopathy were seen with103Pd than125I (3 years: 47.3% vs. 63.9%, p = 0.016), with radionuclide significant in MVA.
  
  
  
  Both125I and103Pd achieve excellent tumor control. An increased probability of long-term VA better than 20/40 and reduced risk of radiation retinopathy is associated with103Pd.
authors.affiliation: Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: krpate8@emory.edu.
authors.forename: Kirtesh R
authors.initials: KR
authors.lastname: Patel
authors.affiliation: Southeast Radiation Oncology Group, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC.
authors.forename: Roshan S
authors.initials: RS
authors.lastname: Prabhu
authors.affiliation: Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Switchenko
authors.affiliation: Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA; Department of Radiation Oncology, Rush University Medical Center, Chicago, IL.
authors.forename: Mudit
authors.initials: M
authors.lastname: Chowdhary
authors.affiliation: Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Craven
authors.affiliation: Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Pia
authors.initials: P
authors.lastname: Mendoza
authors.affiliation: Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Danish
authors.affiliation: Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Hans E
authors.initials: HE
authors.lastname: Grossniklaus
authors.affiliation: Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Aaberg
authors.affiliation: Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aaberg
authors.affiliation: Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Sahitya
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Butker
authors.affiliation: Department of Ophthalmology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Chris
authors.initials: C
authors.lastname: Bergstrom
authors.affiliation: Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Crocker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010165:Palladium / Q000009:adverse effects / Q000627:therapeutic use*; D011832:Radiation Injuries / Q000209:etiology; D011868:Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D012164:Retinal Diseases / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes; D011868:Radioisotopes; D010165:Palladium; C000615531:Palladium-103; C000614960:Iodine-125
keywords: Choroidal melanoma; Episcleral plaque brachytherapy; Iodine; Palladium