Aims: Ruthenium-106 brachytherapy is an effective method for treating small to medium uveal melanomas. The purpose of this study was to examine its effectiveness and safety in the management of thick posterior uveal melanoma (apical height ≥8.0 mm) and to compare it to enucleation.
Methods: One hundred twenty six consecutive patients with thick uveal melanoma were included. 63 patients treated with Ruthenium-106 brachytherapy were compared with 63 patients treated with enucleation. The main outcome measures were visual acuity, eye retention, local recurrence, metastases, all-cause mortality and melanoma-related mortality.
Results: Patients treated with brachytherapy were significantly younger and had significantly smaller tumors, compared to patients treated with enucleation. Tumor thickness in the brachytherapy group was 9.3 ± 0.9 mm compared to 12.2 ± 1.9mm in the enucleation group. The 5 and 10 years melanoma-related mortality was 20.5% and 46.2% for brachytherapy patients and 28.1% and 44.0% for enucleation patients (p=0.6 and p=0.9). When comparing 15 brachytherapy with 15 matched enucleation patients, the 5- year melanoma-related mortality rates were similar, 28.6% and 33.3% respectively (p = 0.7). Complications associated with brachytherapy included tumor re-growth (n=15), scleral melt (n=3), neovascular glaucoma (n=5) and vitreous hemorrhage (n=3). In the brachytherapy group, no significant difference in survival was noted between patients who did and did not develop local recurrence (p=0.9). Of the eyes that were initially treated with brachytherapy, 71.4% were saved from enucleation. Of them, 70.8% had a final visual acuity of 20/200 or better.
Conclusions: Ruthenium-106 brachytherapy is an alternative to enucleation in some thick posterior uveal melanomas.