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. 2021 Sep;7(4):280-286.
doi: 10.1159/000514649. Epub 2021 May 5.

Choroidal Melanoma with Ultrasound-Guided Episcleral Brachytherapy: Long-Term Results and Risk of Metastasis

Beatriz Quiles  1 , Jorge Mataix  2 , José Luis Guinot  1 , Isabel Wang  1 , Victor De Los Dolores  3 , Marina Peña  1 , Alonso La Rosa  1 , Maribel Tortajada  1 , Miguel Santos  1 , Leoncio Arribas  1
Affiliations

Choroidal Melanoma with Ultrasound-Guided Episcleral Brachytherapy: Long-Term Results and Risk of Metastasis

Beatriz Quiles et al. Ocul Oncol Pathol. 2021 Sep.

Abstract

Introduction: The aim of this study was to elucidate the long-term outcomes in patients with choroidal melanoma who received episcleral brachytherapy with 125-I seeds; analyse cause-specific survival (CSS), metastasis-free survival (MFS), and local control; and establish the relationship between tumour size and metastases.

Methods: From May 2007 to February 2013, 88 patients classified according to the American Joint Committee on Cancer guidelines underwent ultrasound-guided episcleral brachytherapy with a total prescribed dose of 72.40 Gy to the apex.

Results: Among the included cases, 47.7 and 44.3% had a clinical tumour stage of T2 and T3, respectively. With a median follow-up of 84 (range 7-153) months, local control at 5 and 10 years was 100 and 95%, respectively. Among the 88 patients, 9 (10.2%) were enucleated after brachytherapy. Those with T1-T2 and T3-T4 disease had a 10-year CSS of 100 and 87.3%, respectively (p = 0.017). MFS at 5 and 10 years was 100% in those with T1-T2 disease and 92.1 and 83.1% in those with T3-T4, respectively (p = 0.016). Five patients had liver metastases, all of whom had T3-T4 disease.

Conclusion: Ultrasound-guided episcleral brachytherapy with 125-I seeds yielded excellent local control for choroidal melanoma, with low complication rates and 90% eye preservation. Given the association between tumour stage and liver metastases, which remain the main cause of death, stricter control should be employed for T3-T4 tumours for the early detection and treatment of relapses.

Keywords: 125-I; Brachytherapy; Choroidal melanoma; Local control; Metastasis-free survival.

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Figures

Fig. 1
Fig. 1
Metastasis-free survival. MTs versus LTs.
Fig. 2
Fig. 2
Cause-specific survival.
Fig. 3
Fig. 3
Clinical images, before and after treatment. a Choroid melanoma stage T2 (12 × 14 mm, 3.5 mm thick) treated with episcleral brachytherapy with 125-I seeds. b After 5 years, total flattening of the tumour was noted. c Choroid melanoma in the temporary retina stage T3 (17 × 17 mm, 9 mm thick) before treatment. d 2 years after episcleral brachytherapy, thickness 5.5 mm. e 6 years after treatment, coriorretinian atrophy around the tumour and significant reduction in tumour volume was observed, with a thickness of 3 mm.
See this image and copyright information in PMC

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