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

  • Oncology
  • Published:
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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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Authors and Affiliations

  1. Department of Radiation Oncology, 200 UCLA Medical Plaza, Suite B265, University of California, Los Angeles, Los Angeles, CA, 90095, USA

    John V. Hegde, James Lamb, Pin-Chieh Wang, Darlene Veruttipong, D. Jeffrey Demanes & Mitchell Kamrava

  2. Department of Ophthalmology, Stein Eye Institute, 100 Stein Plaza UCLA, University of California, Los Angeles, Los Angeles, CA, 90095, USA

    Tara A. McCannel, Colin A. McCannel & Robert Almanzor

Authors
  1. John V. Hegde
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  2. Tara A. McCannel
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  3. Colin A. McCannel
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  4. James Lamb
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  6. Darlene Veruttipong
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  7. Robert Almanzor
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  8. D. Jeffrey Demanes
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  9. Mitchell Kamrava
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Corresponding author

Correspondence to John V. Hegde.

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Funding

The George E. and Ruth Moss Trust and the Research to Prevent Blindness provided financial support in the form of grant funding. The sponsor had no role in the design or conduct of this research.

Conflict of interest

Aside from the listed author affiliations and funding, the authors certify that they have no other affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hegde, J.V., McCannel, T.A., McCannel, C.A. et al. Juxtapapillary and circumpapillary choroidal melanoma: globe-sparing treatment outcomes with iodine-125 notched plaque brachytherapy. Graefes Arch Clin Exp Ophthalmol 255, 1843–1850 (2017). https://doi.org/10.1007/s00417-017-3703-0

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  • DOI: https://doi.org/10.1007/s00417-017-3703-0

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