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Ruthenium-106 versus iodine-125 plaque brachytherapy of 571 choroidal melanomas with a thickness of ≥5.5 mm
  1. Maria Filì1,2,
  2. Eric Trocme1,3,
  3. Louise Bergman1,
  4. Thonnie Rose Ong See4,
  5. Helder André1,2,
  6. Katarina Bartuma1,2,
  7. Leonard Girnita1,3,
  8. Charlotta All-Eriksson1,2,
  9. Stefan Seregard1,2,
  10. Gustav Stålhammar1,2
  1. 1 St. Erik Eye Hospital, Stockholm, Sweden
  2. 2 Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  3. 3 Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
  4. 4 Departments of Ophthalmology and Pathology, Emory Eye Center, Atlanta, Georgia, USA
  1. Correspondence to Dr Gustav Stålhammar, Ophthalmic Pathology and Oncology Service, St. Erik Eye Hospital, Stockholm 112 30, Sweden; gustav.stalhammar{at}


Background Episcleral brachytherapy is the most common eye-preserving treatment for medium-sized choroidal melanomas. γ-emitting iodine-125 (125I) and β-emitting ruthenium-106 (106Ru) are widely used. The latter is however generally reserved for thinner tumours (<6 mm). In this study, we compare ocular and patient survival in thicker tumours treated with the respective radioisotope.

Methods All patients with ≥5.5 mm thick choroidal melanomas who were treated with plaque brachytherapy at a single institution between 1 November 1979 and 31 December 2015 were included (n=571). Size-controlled Cox regression HRs for postbrachytherapy enucleation, repeated brachytherapy and melanoma-related mortality were calculated, as well as Kaplan-Meier disease-specific survival and relative 10-year survival in matched subgroups.

Results 317 patients were treated with 106Ru and 254 with 125I. The rate of repeated brachytherapy was significantly higher among patients treated with 106Ru (8%) than with 125I (1%, p<0.001). Size-controlled Cox regression HRs for postbrachytherapy enucleation (125I vs 106Ru 0.7, p=0.083) and melanoma-related mortality were not significant (125I vs 106Ru 1.1, p=0.63). Similarly, Kaplan-Meier disease-specific and relative 10-year survival was comparable in matched groups of 5.5–7.4 mm (relative survival 106Ru 59%, 125I 56%) and ≥7.5 mm thick tumours (relative survival 106Ru 46%, 125I 44%).

Conclusions Rates of repeated brachytherapy were significantly higher among patients treated with 106Ru versus 125I for thick choroidal melanomas. There were, however, no significant differences in rates of enucleation or patient survival.

  • neoplasia
  • treatment other

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  • Contributors MF: Collecting data, drafting the article, revising the article. ET: drafting the article, interpretation of data, revising the article. LB: Collecting data. TROS: data analysis, revising the article. HA: Analysis of data. KB: Revising the article. LG: Revising the article. CA-E: Revising the article. SS: Conception, revising the article. GS: Conception, drafting the article, data analysis and interpretation, revising the article. All authors read and approved the final manuscript.

  • Funding Funding/support for this study was provided to Gustav Stålhammar from the St. Erik Eye Hospital, the St. Erik Research Foundation (St. Eriks Ögonforskningsstiftelse), the Swedish Ophthalmological Society, Cronqvists stiftelse (Cronqvist foundation), the Swedish Eye Foundation (ögonfonden) and Karolinska Institutet (Karolinska Institutets stiftelsemedel för ögonforskning).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study adhered to the tenets of the Declaration of Helsinki and the protocol was approved by the regional ethical review board in Stockholm.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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