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. 2024 Apr;10(1):9-14.
doi: 10.1159/000536127. Epub 2024 Jan 16.

Retinal Pigment Epithelial Adenoma: Initial Treatment Outcomes following Episcleral Brachytherapy

Alaa E Fayed  1   2 , Islam Y Swaify  1 , Ayman M Khattab  1 , Tamer A Macky  1 , Dina H Hassanein  1 , Shaymaa H Salah  1 , Abdussalam M Abdullatif  1 , Alia M Noureldine  1 , Mariam R Fadel  1 , Youssef A H Helmy  1 , Ayman G Elnahry  1   3 , Yasmine A Meqdad  1 , Yagmur S Yesiltas  4   5 , Arun D Singh  4   5 , Hany Hamza  1
Affiliations

Retinal Pigment Epithelial Adenoma: Initial Treatment Outcomes following Episcleral Brachytherapy

Alaa E Fayed et al. Ocul Oncol Pathol. 2024 Apr.

Abstract

Introduction: We aim to explore the safety and efficacy of episcleral brachytherapy as a primary management option for eyes with retinal pigment epithelial (RPE) adenoma.

Methods: Retrospective chart review of the demographic, clinical, ancillary, and postoperative outcome data of patients with RPE adenoma in 2 tertiary referral centers. Tumor regression, final visual acuity, and complications were assessed.

Results: Five patients (3 females and 2 males) were included. Four of the 5 eyes had peripheral and mid-peripheral lesions, while one tumor was juxtapapillary. Three eyes were treated with ruthenium-106 (100 Gray), and 2 received iodine-125 episcleral plaques (85 Gray). All eyes showed clinical and imaging-based evidence of regression. Four eyes had stable or improved visual acuity, while 1 eye exhibited one line loss of visual acuity due to radiation retinopathy. Local recurrence was not observed in any eye over a median follow-up of 24 (range 6-112) months.

Conclusions: Episcleral brachytherapy is an effective management option for select cases of RPE adenoma that is capable of achieving tumor regression while maintaining favorable visual acuity. The initial safety profile of brachytherapy is good without significant vision-compromising complications.

Keywords: Adenoma; Brachytherapy; Episclera; Radiotherapy; Retinal pigment epithelium.

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Conflict of interest statement

All authors certify that they have no conflict of interest in the subject matter or materials discussed in this manuscript.

Figures

Fig. 1.
Fig. 1.
RPE adenoma treated with Ruthenium-106 episcleral brachytherapy. Case 1 with fundus (a1) and B scan (a2) appearance before and 24 months after therapy. Note the resolution of exudation, and tumor regression on fundus photograph (a3) and B scan (a4). Case 2 with fundus (b1) and B-scan (b2) appearance before and 6 months after therapy. Note the resolution of exudation, and tumor regression on fundus photograph (b3) and B-scan (b4). Case 3 with fundus (c1) and B-scan (c2) appearance before and 18 months after therapy. Note the resolution of exudation, and tumor regression on fundus photograph (c3) and B-scan (c4).
Fig. 2.
Fig. 2.
RPE adenoma treated with Iodine-125 episcleral brachytherapy. Case 4 with fundus (a1) and B-scan (a2) appearance before and 24 months after therapy. Note the resolution of exudation, and tumor regression on fundus photograph (a3) and B-scan (a4). Case 5 with fundus (b1) and B-scan (b2) appearance before and 112 months after therapy. Note the resolution of exudation, and tumor regression on fundus photograph (b3) and B-scan (b4). In both cases, diagnostic fine-needle aspiration biopsy showed bland cuboidal cells with pigment granules (suggestive of RPE cells) and absent spindle or epithelioid cells of melanoma. Prognostic testing was not done.
See this image and copyright information in PMC

References

    1. Williams BK Jr, Di Nicola M, Acaba-Berrocal LA, Milman T, Mashayekhi A, Lucio-Alvarez JA, et al. . Adenoma and adenocarcinoma of the retinal pigment epithelium: a review of 51 consecutive patients. Ophthalmol Retina. 2020;4(8):829–39. - PubMed
    1. Shields JA, Shields CL, Gündüz K, Eagle RC Jr. Neoplasms of the retinal pigment epithelium: the 1998 Albert Ruedemann, Sr, memorial lecture, Part 2. Arch Ophthalmol. 1999;117(5):601–8. - PubMed
    1. Traboulsi EI, Scaramuzzi M, Singh AD. Retinal pigment epithelial tumors. In: Singh AD, Damato BE, editors. Clinical ophthalmic Oncology: retinal tumors. Cham: Springer International Publishing; 2019. p. 51–69.
    1. Shields JA, Eagle RC Jr, Shields CL, Brown GC, Lally SE. Malignant transformation of congenital hypertrophy of the retinal pigment epithelium. Ophthalmology. 2009;116(11):2213–6. - PubMed
    1. Trichopoulos N, Augsburger JJ, Schneider S. Adenocarcinoma arising from congenital hypertrophy of the retinal pigment epithelium. Graefes Arch Clin Exp Ophthalmol. 2006;244(1):125–8. - PubMed