Management of Iris Melanomas With 125Iodine Plaque Radiotherapy
Accepted 6 August 2009. published online 04 November 2009.
Purpose
To report the experience of the Princess Margaret Hospital/University Health Network with the treatment of iris melanoma (IM) with 125Iodine plaque brachytherapy.
Design
Retrospective noncomparative case series.
Methods
All cases of IM submitted to 125Iodine plaque radiotherapy were included. Patients' demographic, clinical, management, and follow-up data were reviewed. Outcome measures included rates of tumor control, eye preservation, systemic metastases, and brachytherapy-related complications.
Results
Fourteen IMs were included in the study. All patients had blue/green irises. Mean largest basal dimension and thickness were 7.1 ± 2.1 mm (range, 4.0 to 11.5 mm) and 2.2 ± 0.8 mm (range, 1.0 to 3.5 mm), respectively. Ten patients (71%) had seeding and 2 (14%) had glaucoma at presentation. Median follow-up was 26.6 ± 19.5 months (range, 6 to 72 months). Tumor control was achieved in 100% of the cases and no eye was enucleated because of radiation-induced complications. At last visit, all patients were alive and free of metastasis. Final visual acuity was the same as or better than before treatment in 9 patients (75%). Cataract was the most common complication (8; 75%), followed by persistent glaucoma (2; 17%) and anterior uveitis (1; 8%). No other significant complication was seen during the follow-up period.
Conclusions
Plaque radiotherapy is a safe and effective conservative treatment option for IM, although cataract is a common, yet treatable, complication. This treatment scheme circumvents an intraocular procedure and may avoid the dissemination of malignant cells, and provides a margin of safety in the treatment of clinically undetectable disease.
aDepartment of Ocular Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
bDepartment of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
Inquiries to Bruno F. Fernandes, 600 University Street, Room 18-706, Toronto, ON M5G-2M9, Canada
ABSTRACT