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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-09-2017 | Oncology

Juxtapapillary and circumpapillary choroidal melanoma: globe-sparing treatment outcomes with iodine-125 notched plaque brachytherapy

Authors: John V. Hegde, Tara A. McCannel, Colin A. McCannel, James Lamb, Pin-Chieh Wang, Darlene Veruttipong, Robert Almanzor, D. Jeffrey Demanes, Mitchell Kamrava

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 9/2017

Abstract

Purpose

Managing juxtapapillary and circumpapillary choroidal melanoma with brachytherapy is challenging because of technical complications with accurate plaque placement and high radiation toxicity given tumor proximity to the optic nerve. We evaluated our center’s experience using ultrasound-guided, Iodine (I)-125 notched plaque brachytherapy for treating choroidal melanoma contiguous with (juxtapapillary) and at least partially surrounding the optic disc (circumpapillary).

Methods

All cases of choroidal melanoma treated with I-125 notched plaque brachytherapy at our center from September 2003–December 2013 were retrospectively reviewed. Only patients with ≥18 months of follow-up who had lesions contiguous with the optic disc (0 mm of separation) were included. The tumor apex prescription dose was 85 Gy. Outcomes evaluated included local control, distant metastasis-free survival (DMFS), cancer-specific survival (CSS), overall survival (OS), visual acuity, and radiation toxicity.

Results

Thirty-four patients were included with a median follow-up of 44.1 months (range 18.2–129.0). AJCC T-category was T1 in 58.8%, T2 in 26.5%, and T3 in 14.7%. Median circumferential optic disc involvement was 50% (range 10%–100%). Eye retention was achieved in 94.1%. Actuarial 2- and 4-year rates of local recurrence were 3.1% and 7.6%, DMFS were 97.0% and 88.5%, CSS were 97.0% and 92.8%, and OS were 97.0% and 88.9%, respectively. In addition, 23.5% had visual acuity ≥20/200 at last follow-up.

Conclusions

I-125 notched plaque brachytherapy provides high eye preservation rates with acceptable longer-term post-treatment visual outcomes. Based on our experience, choroidal melanoma directly contiguous with and partially encasing the optic disc may be effectively treated with this technique.

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Title: Juxtapapillary and circumpapillary choroidal melanoma: globe-sparing treatment outcomes with iodine-125 notched plaque brachytherapy
Authors: John V. Hegde
Tara A. McCannel
Colin A. McCannel
James Lamb
Pin-Chieh Wang
Darlene Veruttipong
Robert Almanzor
D. Jeffrey Demanes
Mitchell Kamrava
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 9/2017
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-017-3703-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Juxtapapillary and circumpapillary choroidal melanoma: globe-sparing treatment outcomes with iodine-125 notched plaque brachytherapy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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