Plaque Brachytherapy for Circumpapillary, Juxtapapillary and Peripapillary Choroidal Melanoma

Theme: Retina*
What: Retina
Part of: Retina III: A Passionate Potpourri for Pinching Out Pathology / Rétine III: Pot-pourri passionné pour éliminer les pathologies
When: 6/2/2024, 11:15 AM - 12:45 PM
Where: Room | Salle 713 AB

Abstract

Purpose: To evaluate the treatment of circumpapillary, juxtapapillary and peripapillary choroidal melanomas using plaque brachytherapy, including visual outcomes, treatment failure and mortality data.

Study Design: Retrospective single-center study of 202 patients treated with iodine-125 plaque brachytherapy for circumpapillary (n=80), juxtapapillary (n=59), peripapillary (n=63) choroidal melanoma from January 2012 to September 2023.

Methods: Ethics approval was obtained from the Health Research Ethics Board for Alberta-Cancer Committee. Tumor distance from the optic nerve was measured with indirect ophthalmoscopy or from calibrated plaque brachytherapy photos. All patients were treated through the provincial ocular brachytherapy program by one surgeon (EW). Baseline examinations included ETDRS visual acuity, fundus photography, ultrasound (A- and B-scan), 24-2 visual field (SITA-standard), slit-lamp and fundus examinations. Studies from baseline examinations were completed annually. A significant reduction in visual acuity was defined as a best corrected visual acuity < or = 20/200. Significant central vision loss on visual field was defined as a cluster of >3 abnormal points (p<5%) on pattern-deviation plot with at least 1 point with p<1%, looking at the central 12 points (24 degrees). Patients were followed up to 5 years for visual endpoints, and to present day for metastatic disease and mortality data.

Results: The median follow up duration was 4.00 years for all patients, with 101 patients (50%) followed for at least 5 years. 95.5% of patients were treated with a notched episcleral plaque. 56 patients (27.7%) received prophylactic adjuvant treatment with transpupillary thermotherapy. At present, 1 patient (0.495%) has had local treatment failure requiring enucleation. 23 patients (11.4%) were diagnosed with metastatic disease post-brachytherapy. All cause mortality was 13.7% (28 patients) and melanoma-specific mortality was 7.92% (16 patients). At present, 73 patients have been followed for 5 years with reliable fields. 53.4% had central field loss at baseline, with a cumulative 91.8% of patients at 3 years and 97.3% at 5 years. At present, 79 patients have a complete 5 years of visual acuity data available. 45.6% had a visual acuity  < or = 20/200 at 1 year, with a cumulative 70.9% of patients at 3 years and 83.5% at 5 years.

Conclusions: Plaque brachytherapy provides excellent local control with high rates of globe conservation for choroidal melanomas in close proximity to the optic nerve. The majority, but not all, patients will experience significant visual impairment.  

Financial Disclosures: None

 

Presenter(s)

Presenting Author: Julia Wiens

Additional Author(s):

Matthew Larocque, Alberta Ocular Brachytherapy Program

Albert Murtha, Alberta Ocular Brachytherapy Program

Geetha Menon, Alberta Ocular Brachytherapy Program

Ezekiel Weis, Alberta Ocular Brachytherapy Program

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