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. 2025 Jan 11;45(1):23.
doi: 10.1007/s10792-024-03381-6.

Ruthenium-106 brachytherapy and central uveal melanoma

Luise Grajewski  1 , Christiane Kneifel  2 , Markus Wösle  3 , Ilja F Ciernik  3 , Lothar Krause  2
Affiliations

Ruthenium-106 brachytherapy and central uveal melanoma

Luise Grajewski et al. Int Ophthalmol. .

Abstract

Purpose: Uveal melanoma (UM) is the most common primary ocular malignancy. The size and location of the tumor are decisive for brachytherapy with the β-emitting ruthenium-106 (Ru-106) plaque. The treatment of juxtapapillary and juxtafoveolar UM may be challenging because of the proximity or involvement of the macula and optic nerve and high recurrence rates.

Methods: Central UMs were defined as lesions up to 5 mm off the optic disc or fovea radius of 5 mm. Between January 2011 and July 2020, we treated 56 patients with Ru-106-brachytherapy. The clinical outcomes for recurrence, visual acuity, and radiation-related toxicity were assessed. The follow-up was 66 (6-136) months.

Results: Of the 56 patients (56 eyes), 8 (14%) suffered from local recurrence. Six relapsing UM in 19 (32%) patients were located close to the optic disc, and two patients had UM close to the macula (2/37, 5%) (p > 0.05). The overall eye-preservation rate was 89%. The pretreatment visual acuity (VA) was 0.45 and reduced to 0.26 after brachytherapy. Radiation retinopathy or optic neuropathy was detected in 7 (13%) patients and radiation maculopathy in 10 (17.9%). Six patients (11%) underwent enucleation for recurrence or radiation-induced ophthalmopathy.

Conclusion: Central UMs are challenging to treat. UMs should be categorized as lesions laterally or medially to the fovea because of different long-term control rates. Localization near the optic disc requires thoughtful management.

Keywords: Brachytherapy; Central; Ruthenium; Uveal melanoma.

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Conflict of interest statement

Declarations. Conflict of interests: The authors have no relevant financial or non-financial interests to disclose. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirm that human research participants provided informed consent for publication of the images (Figs. 1, 5a and b). Ethics approval: This is an observational retrospective study. Therefore no ethical approval is required in Germany.

Figures

Fig. 1
Fig. 1
Categorization of tumor presentation according to the location in relation to the fovea. The fundus of a right eye: 1, group I; 2, group II; X, fovea; O, optic disc
Fig. 2
Fig. 2
Change in visual acuity in groups I and II. The mean values are shown with the “standard error of the mean” dispersion measure
Fig. 3
Fig. 3
Kaplan–Meier curves (solid lines) of fully observed and right-censored data with lower and upper confidence bounds (dashed lines) for the Groups I and II
Fig. 4
Fig. 4
Kaplan–Meier curves (solid lines) of fully observed and right-censored data with lower and upper confidence bounds (dashed lines) for the tumor stages T1 and T2 to T3 (T2 and T3 in one group because only one single tumor of size T3 recurred)
Fig. 5
Fig. 5
A case of a patient with a CM in group II: a VA 1.0; height, 2.4 mm. b 90 months after brachytherapy, VA 0.8; height, 1.4 mm
See this image and copyright information in PMC

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