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Comparative Study
. 2017 May-Jun;16(3):646-653.
doi: 10.1016/j.brachy.2017.01.012. Epub 2017 Mar 3.

Visual acuity, oncologic, and toxicity outcomes with 103Pd vs. 125I plaque treatment for choroidal melanoma

Kirtesh R Patel  1 , Roshan S Prabhu  2 , Jeffrey M Switchenko  3 , Mudit Chowdhary  4 , Caroline Craven  5 , Pia Mendoza  5 , Hasan Danish  6 , Hans E Grossniklaus  5 , Thomas M Aaberg Sr  5 , Thomas Aaberg Jr  5 , Sahitya Reddy  5 , Elizabeth Butker  6 , Chris Bergstrom  5 , Ian R Crocker  6
Affiliations
Comparative Study

Visual acuity, oncologic, and toxicity outcomes with 103Pd vs. 125I plaque treatment for choroidal melanoma

Kirtesh R Patel et al. Brachytherapy. 2017 May-Jun.

Abstract

Purpose: To evaluate outcomes of choroidal melanoma patients treated with 125I or 103Pd plaque brachytherapy.

Methods and materials: From 1993 to 2012, our institution treated 160 patients with 103Pd (56.1%) and 125 patients with 125I (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.

Results: Median followup was longer for 125I 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). Both 103Pd and 125I 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 with 103Pd (63% vs. 35%, p = 0.007) at 3 years. MVA demonstrated 103Pd 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 23 125I with 107 103Pd 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 with 103Pd than 125I (3 years: 47.3% vs. 63.9%, p = 0.016), with radionuclide significant in MVA.

Conclusions: Both 125I and 103Pd achieve excellent tumor control. An increased probability of long-term VA better than 20/40 and reduced risk of radiation retinopathy is associated with 103Pd.

Keywords: Choroidal melanoma; Episcleral plaque brachytherapy; Iodine; Palladium.

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Conflict of interest statement

Conflict of interest: None.

Figures

Fig. 1
Fig. 1
Estimated overall survival for treatment with 125I compared with 103Pd. Curve is truncated at 84 months. CI = confidence interval.
Fig. 2
Fig. 2
Estimated secondary enucleation (a) and distant metastases-free survival (b) for treatment with 125I compared with 103Pd. Curve is truncated at 84 months.
Fig. 3
Fig. 3
Estimated rate of developing radiation retinopathy or vitreous hemorrhage with 125I compared with 103Pd. Curve is truncated at 60 months.
See this image and copyright information in PMC

References

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