title: Early outcomes of uveal melanoma treated with intraoperative ultrasound guided brachytherapy using custom built plaques.
abstract: OBJECTIVE
  To report early outcomes of patients with uveal melanoma treated with Eye Physics iodine-125 episcleral plaque therapy using modern biopsy techniques and intraoperative ultrasound guidance at our institution.
  
  
  METHODS
  A retrospective chart review was conducted for 48 consecutive patients with uveal melanoma who were treated with Eye Physics plaque brachytherapy performed by 1 ocular oncologist. All patients underwent intraoperative ultrasound for image guidance of plaque placement. A dose of 85 Gy was prescribed to the apical height of the tumor or 5 mm from the inner sclera, whichever was greater. Forty-five patients underwent biopsy. Visual acuity, complication data, and recurrence rates were recorded.
  
  
  RESULTS
  Median age at presentation was 63.0 years (range, 19-86 years). Median follow-up was 21.6 months. Median tumor apical height was 3.3 mm (range, 1.8-11.5 mm). Median dose at apex for tumor height >5 mm was 85.0 Gy and 142.5 Gy for tumor height ≤5 mm. Mean percent decrease in tumor height from baseline at 12, 24, and 36 months was 39.6%, 51.8%, and 53.8%, respectively. At 24 months, 19/23 (82.6%) patients maintained vision within 3 lines of baseline visual acuity. Twelve patients developed radiation retinopathy, 6 of whom were treated with anti-vascular endothelial growth factor therapy in the context of a clinical trial. No patients to date have local failure. Three patients are alive with confirmed hepatic metastases.
  
  
  CONCLUSIONS
  We reported 0% early local failure rate and steady reduction in tumor height in 48 patients with uveal melanoma, ranging from small to large size, who were treated with Eye Physics iodine-125 episcleral plaque therapy using intraoperative ultrasound guidance. This promising result emphasizes the importance of image guided brachytherapy with intraoperative ultrasound at the time of plaque placement.
authors.affiliation: Department of Radiation Oncology, University of Texas Medical Branch, Galveston, Texas; Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Tann
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas; Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas. Electronic address: bteh@houstonmethodist.org.
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Scarboro
authors.affiliation: Department of Radiation Oncology, University of Texas Medical Branch, Galveston, Texas; Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Lewis
authors.affiliation: Retina Consultants of Houston, Houston, Texas.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Bretana
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas.
authors.forename: Porshea C
authors.initials: PC
authors.lastname: Croft
authors.affiliation: Oncology Consultants, Houston, Texas.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Raizen
authors.affiliation: Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas; Department of Radiation Oncology, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.
authors.forename: E Brian
authors.initials: EB
authors.lastname: Butler
authors.affiliation: Retina Consultants of Houston, Houston, Texas; McGovern Medical School at The University of Texas Health Science Center, Houston, Texas.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Kim
authors.affiliation: Ophthalmology, Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Pathology and Laboratory Medicine, Weill Cornell Medicine, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chevez-Barrios
authors.affiliation: Retina Consultants of Houston, Houston, Texas; Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Schefler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging*; D055815:Young Adult; D000098943:Uveal Melanoma