Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy

Abstract

Uveal melanoma is the most common primary intraocular malignancy. The aim of this retrospective study was to report the results after ruthenium-106 (Ru-106) plaque brachytherapy for uveal melanoma in terms of tumor control, visual acuity, radiation-related complications, tumor recurrence, metastases, and patients' survival rate during 4 years' follow-up. A total of 355 eyes from 355 patients have been treated with Ru-106 plaque brachytherapy for uveal melanoma between February 2011 and March 2020. Five patients were lost to follow-up, and then 350 eyes of 350 patients (mean age 58 ± 11 years) were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination including echography and spectral domain-optical coherence tomography. The mean follow-up was 4 years (3 months to 9 years). After treatment, the mean tumor thickness was reduced to 1.75 ± 0.21 mm. Radiation complications were found in 63% of patients: 38% showed radiation maculopathy, 11% had optic neuropathy, and 14% developed cataracts. Cancer-free survival was 99%, 97%, and 85%, respectively, at 5, 7, and 9 years. Ru-106 plaque brachytherapy represents a reliable treatment of uveal melanoma. This technique is valid and safe with a low rate of ocular complications during a long-term follow-up.

Keywords: complications; local recurrence; metastasis; ruthenium-106 brachytherapy; survival rate; uveal melanoma.

Figure 1

Right eye of a 57-year-old patient affected by choroidal melanoma before ruthenium-106 brachytherapy (top row). Color fundus image shows an elevated and yellow lesion in the nasal mid-peripheral of the retina (A). At A-scan ultrasound, the lesion presents low reflectivity. The yellow arrows over the peaks of the two high and perpendicular spikes, as shown in the echogram, indicate the maximum lift of 3.61 mm (B). Spectral domain–optical coherence tomography (SD-OCT) B-scan over the lesion revealed a highly reflective band within the choriocapillaris layer with posterior shadowing (C). SD-OCT B-scan shows no alteration of the retinal layer architecture in the macular region (D). Color fundus image shows the same tumor after ruthenium-106 brachytherapy (A1). At A-scan ultrasound, the lesion presents high reflectivity with a tumor thickness of 2.23 mm (B1) confirmed also by the OCT B-scan (C1). OCT B-scan shows no alteration of the retinal layers architecture in the macular region (D1).

Figure 2

Left eye of a 62-year-old patient affected by choroidal melanoma before ruthenium-106 brachytherapy (top row). Color fundus image shows an elevated and yellow lesion located at the posterior pole (A). A-scan echography shows low reflectivity. The yellow arrows over the peaks of the two high and perpendicular spikes, as shown in the echogram, indicate a tumor thickness of 2.95 mm (B). Spectral domain–optical coherence tomography (SD-OCT) B-scan over the lesion reveals a highly reflective band within the choriocapillaris layer with posterior shadowing (C) and normal central retinal thickness with rare intraretinal cysts in the macular region (D). Color fundus image shows the same tumor after ruthenium-106 brachytherapy (A1). At A-scan ultrasound, the lesion presented high reflectivity with a tumor thickness of 2.15 mm (B1), confirmed also by the SD-OCT B-scan (C1) that shows in the macular region an increased central foveal thickness with intraretinal cysts due to the radiation maculopathy (D1).

Figure 3

Overall survival outcomes, using the Kaplan–Meier analysis, were 99%, 97%, and 85%, at 5, 7, and 9 years, respectively.