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. 2014 May 1;89(1):127-36.
doi: 10.1016/j.ijrobp.2014.01.026. Epub 2014 Mar 7.

Uveal melanoma treated with iodine-125 episcleral plaque: an analysis of dose on disease control and visual outcomes

Bradford A Perez  1 , Pradeep Mettu  2 , Lejla Vajzovic  2 , Douglas Rivera  3 , Ali Alkaissi  1 , Beverly A Steffey  1 , Jing Cai  1 , Sandra Stinnett  4 , Jonathan J Dutton  5 , Edward G Buckley  2 , Edward Halperin  6 , Lawrence B Marks  7 , Prithvi Mruthyunjaya  8 , David G Kirsch  9
Affiliations

Uveal melanoma treated with iodine-125 episcleral plaque: an analysis of dose on disease control and visual outcomes

Bradford A Perez et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To investigate, in the treatment of uveal melanomas, how tumor control, radiation toxicity, and visual outcomes are affected by the radiation dose at the tumor apex.

Methods and materials: A retrospective review was performed to evaluate patients treated for uveal melanoma with (125)I plaques between 1988 and 2010. Radiation dose is reported as dose to tumor apex and dose to 5 mm. Primary endpoints included time to local failure, distant failure, and death. Secondary endpoints included eye preservation, visual acuity, and radiation-related complications. Univariate and multivariate analyses were performed to determine associations between radiation dose and the endpoint variables.

Results: One hundred ninety patients with sufficient data to evaluate the endpoints were included. The 5-year local control rate was 91%. The 5-year distant metastases rate was 10%. The 5-year overall survival rate was 84%. There were no differences in outcome (local control, distant metastases, overall survival) when dose was stratified by apex dose quartile (<69 Gy, 69-81 Gy, 81-89 Gy, >89 Gy). However, increasing apex dose and dose to 5-mm depth were correlated with greater visual acuity loss (P=.02, P=.0006), worse final visual acuity (P=.02, P<.0001), and radiation complications (P<.0001, P=.0009). In addition, enucleation rates were worse with increasing quartiles of dose to 5 mm (P=.0001).

Conclusions: Doses at least as low as 69 Gy prescribed to the tumor apex achieve rates of local control, distant metastasis-free survival, and overall survival that are similar to radiation doses of 85 Gy to the tumor apex, but with improved visual outcomes.

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Conflict of interest statement

Conflict of Interest Statement: Other conflicts of interest: none

Figures

Figure 1
Figure 1. Treatment Outcomes with I-125 Plaques Among 190 Patients with Uveal Melanoma
(A) Local Failure Free Survival by Apex Dose Quartile (B) Metastasis Free Survival by Apex Dose Quartile (C) Overall Survival by Apex Dose Quartile
Figure 2
Figure 2. Eye Preservation and Radiation Treatment (RT) Complications with I-125 Plaques Among 190 Patients with Uveal Melanoma
(A) Enucleation Free Survival by Apex Dose Quartile (B) Enucleation Free Survival by 5 mm Dose Quartile (C) Any Radiation Related Toxicity Free Survival including retinopathy, optic neuropathy, cataract, neovascular glaucoma, and keratopathy by Apex Dose Quartile (D) Any Radiation Related Toxicity Free Survival by 5 mm Dose Quartile
Figure 3
Figure 3. Visual Acuity with I-125 Plaques Among 190 Patients with Uveal Melanoma
(A) Visual Acuity Loss by Apex Dose Quartile (B) Visual Acuity Loss by 5 mm Dose Quartile (C) Risk of greater than or equal to 3 lines of visual acuity loss by apex dose quartile (left) and apex dose among patients with less than 3 lines of visual acuity loss compared to greater than 3 lines of visual acuity loss (right) (D) Risk of greater than or equal to 3 lines of visual acuity loss by 5 mm dose quartile (left) and 5 mm dose among patients with less than 3 lines of visual acuity loss compared to greater than 3 lines of visual acuity loss (right) (E) Risk of final visual acuity worse than or equal to 20/200 by apex dose quartile (left) and apex dose among patients with visual acuity better than 20/200 compared to worse than or equal to 20/200 (right) (F) Risk of final visual acuity worse than or equal to 20/200 by 5 mm dose quartile (right) and 5mm dose among patients with visual acuity better than 20/200 compared to worse than or equal to 20/200 (right)
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