Survival, anatomic, and functional long-term results in choroidal and ciliary body melanoma after ruthenium brachytherapy (15 years’ experience with beta-rays) - 25/08/11
, P. Roy, MD, PhD b, L. Kodjikian, MD a, J.P. Gérard, MD c, B. Jean-Louis, MD a, J.D. Grange, MD aAbstract |
Purpose |
To analyze survival, radiation-related complications, local recurrence, enucleation, and visual acuity after ruthenium-106 irradiation of malignant uveal melanoma.
Design |
Retrospective study.
Methods |
A total of 213 patients treated with ruthenium-106 brachytherapy between 1983 and 1995. End point rates were estimated by life tables, and prognostic factors by Cox proportional hazards regression. Main outcome measures were survival rate, radiation-related maculopathy, radiation-related vascular occlusion, local tumor recurrence, enucleation, and visual acuity (<20/100 at 3 years).
Results |
At 5 and 10 years, survival was 82% (standard error [SE] 2.7%) and 72% (SE 3.4%), local recurrence 21.7% (SE 3.0%) and 24.3% (SE 3.2%), and enucleation 18.0% (SE 2.7%) and 19.2% (SE 2.8%), respectively. Sixty-one patients showed maculopathy (29%), 36 retinal vascular occlusion (17%), in 33 local recurrence (16%), and 38 enucleation (18%). Age and large tumor diameter were independently associated with survival (P < .0001 and P < .0075, respectively). Age below 40 and melanoma located posteriorly were significant risk factors for maculopathy (P < .0085 and P < .0004, respectively) and vascular occlusion (P < .0415 and P < .0114, respectively). Diameter and Bruch membrane rupture were significant predictors (P < .0032 and P < .0390, respectively) of local recurrence. Visual acuity <20/100 was observed in only 26 of 97 (27%) cases of anterior but 34 of 42 (81%) of posterior tumor (P < .001).
Conclusion |
Although percentage tumor recurrence was high, survival was comparable to series using other treatments. Radiation-related complication rates were acceptable, especially for anterior tumors. Ruthenium therapy can, therefore, be recommended for small and medium-sized tumors with anterior location.
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Vol 137 - N° 5
P. 893-900 - mai 2004 Retour au numéro
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