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Small choroidal melanoma: outcomes following apical height dose brachytherapy
  1. Renato Jose Yupari1,
  2. James Bena2,
  3. Allan Wilkinson3,
  4. John Suh3,
  5. Arun Singh4
  1. 1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  2. 2Department of Quantitative Health, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Cole Eye Insititute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Arun Singh, Cole Eye Institute, 9500 Euclid Avenue, Cleveland, OH OH 44195, USA;singha{at}


Aim To assess the outcomes of small choroidal melanoma following iodine-125 episcleral brachytherapy (apical height dose of 85 Gy).

Methods Patients with small choroidal melanoma that underwent iodine-125 episcleral brachytherapy between January 2004 and December 2017 were reviewed. Inclusion criterion for this study was the COMS small tumour size (tumour apical height of 1.0–2.5 mm and largest basal diameter (LBD) <16.0 mm). Patients that received any form of prior therapy or adjuvant transpupillary thermotherapy were excluded. Outcome measures were visual acuity (VA), recurrence, ocular survival and metastasis at 3 years. Kaplan-Meier estimation was calculated for VA, recurrence, ocular survival and survival outcome (overall and metastasis-free survival rate) at 3 years.

Results 161 cases of choroidal melanoma were included in this study, with the mean (SD) age of 59.6 (14.1) years, and 93 (58%) were males. The mean (SD) apical height for the tumours were 2.1 (0.4) mm and mean (SD) LBD was 8.3 (2.2) mm. The mean (SD, median) follow-up was 40.7 months (37.1, 25 months). The VA was 20/50 or better in 69%. Only one recurrence event (1%) and one enucleation event (1%) were observed. Overall survival was 97%, and no metastatic events were observed at 3 years.

Conclusion Small choroidal melanomas treated with iodine-125 episcleral brachytherapy have excellent outcomes. The majority (69%) of patients retained VA of 20/50 or better with very high local control and ocular survival rate (99.3%) with the absence of metastasis (100%).

  • Choroid
  • Neoplasia
  • Treatment other

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  • Contributors RJY: data collection, interpretation, drafting, critical revision of the manuscript. JB: data analysis and interpretation, critical revision of manuscript. AW: study design, data acquisition, data interpretation, drafting manuscript. JS: data interpretation, drafting of manuscript and interpretation. AS: study design, data interpretation, drafting manuscript, critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Data availability statement Data are available upon reasonable request.

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