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The treatment of uveal melanoma with iodine plaque brachytherapy
Author(s) -
KIVELÄ T
Publication year - 2009
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2009.4266.x
Subject(s) - enucleation , brachytherapy , medicine , collimated light , melanoma , radioactive iodine , margin (machine learning) , iodine , radiation therapy , nuclear medicine , radiology , surgery , thyroid , optics , computer science , materials science , laser , physics , cancer research , machine learning , metallurgy
Purpose To provide an overview of managing uveal melanoma (UM) with iodine brachytherapy (IBT). Methods Personal experience of the author in using IBT since 1990. Results IBT is an effective option for managing a UM of any size, although it is mostly used for medium‐sized tumours, preference being given to ruthenium brachytherapy (RBT) when the tumour is <5‐6 mm thick and to transscleral local resection when thickness is >6 mm, especially when vision is good. IBT is also a safe alternative to enucleation of large UM >10 mm in thickness if the patient is keen to preserve the eye and motivated to accept eventual complications. The plaque is positioned over the UM with a 1‐2 mm safety margin when using a collimated/rimmed plaque. Because of stray radiation, a safety margin is not mandatory when the plaque is non‐collimated/non‐rimmed. Otherwise, surgical technique does not differ from RBT. An advantage of IBT is that the radioactive seeds are separate from the plaque, allowing economical use of plaques of many different sizes and shapes and individual positioning of the seeds in a conformal way. A disadvantage is a short half‐life; the seeds need to be changed every 6 months. The dose the author uses is 80 Gy to tumour apex, which is reduced on an individual basis to 60‐70 Gy when the UM is very thick. Local tumour control rate is 90% and, paradoxically, not worse for large UM as compared to smaller ones. There are no unequivocal safety distances for avoiding radiation cataract, maculopathy and optic neuropathy, which are more or less frequent depending on the size and location of the UM. Conclusion IBT achieves good local tumour control of UM of all sizes, but preservation of vision is decidedly less frequent than after RBT, which is always given preference.