Plaque radiation therapy for malignant melanoma of the iris and ciliary body☆
Section snippets
Materials and methods
Patients were diagnosed as having uveal melanoma by clinical examination. Small iridociliary melanomas were watched for evidence of growth before treatment. All patients were told of the most common methods of treatment (observation for growth, iridectomy, iridocyclectomy, and enucleation) and were given the option for localized radiation therapy.
Informed consent was obtained after discussion of the findings, alternatives of treatment, potential benefits, and complications. This included a
Results
Plaque radiotherapy was administered to 22 eyes of 22 patients with melanoma involving the iris and ciliary body (Table 1). Tumors in this series had mean base diameters of 7.5 (width range, 4 to 12 mm) by 6.7 mm (length range, 4 to 12 mm) and average heights of 3.2 mm (range, 2 to 6.6 mm). No patient had a large-sized melanoma defined by a tumor height greater than 10 mm or a basal dimension greater than 16 mm (Table 1).
Tumor locations were defined as iris, iris and ciliary body, or were
Discussion
Ophthalmic plaque radiation therapy offers a method to treat iris and ciliary body tumors without the risks associated with intraocular surgery.7, 8, 12, 13, 14, 19 Ophthalmic plaques are sutured onto the episclera to cover the tumor’s base (plus 2 to 3 mm). Then ionizing radiation penetrates the intact selera and cornea before sterilizing the intraocular melanoma. Thus, the targeted zone includes the sclera beneath the tumor, the intraocular melanoma, and a margin for safety.
There have been
Conclusion
Ophthalmic plaque radiotherapy was used to treat 22 patients with uveal melanomas involving the iris and ciliary body. In this series, there was no failure of local control or secondary enucleation. In contrast to intraocular excision surgeries, there was no secondary retinal detachment, intraocular hemorrhage, infection, or potential for tumor seeding.
Radiation was associated with a high incidence of secondary cataract and no radiation maculopathy (within our follow-up period). Despite the
Acknowledgements
The author hereby acknowledges the clinical contributions of Drs Berson and Szechter in radiotherapy and dosimetry.
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Cited by (0)
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This work was supported (in part) by The EyeCare Foundation, Inc, New York, New York.
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Dr Finger is a paid consultant for Theragenics Corporation, Buford, Georgia, USA.