Elsevier

Ophthalmology

Volume 109, Issue 10, October 2002, Pages 1850-1854
Ophthalmology

Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy

https://doi.org/10.1016/S0161-6420(02)01174-0Get rights and content

Abstract

Objective

To evaluate late (more than 5 years) radiation failures after uveal melanoma treatment.

Design

Comparison of three retrospective, interventional, partially randomized case series.

Participants

Nine hundred ninety-six patients who were treated in several phase I, II, and III trials of uveal melanoma radiation.

Main outcome measures

Follow-up period, treatment history, recurrence rates, type of recurrence, and mortality associated with late local recurrences.

Results

Eleven of 996 irradiated uveal melanoma patients experienced intraocular recurrence more than 5 years after radiation. All 11 of these patients were treated with iodine 125 (125I) brachytherapy. Late recurrences were detected between 5.5 to 15.3 years after treatment. These patients did not have either high-risk clinical parameters (thin, posterior tumors in proximity to the optic nerve) or radiation dosimetry characteristics (low dose-delivery radiation) associated with a known increased risk for tumor recurrence after radioactive plaques. The annualized incidence rate for regrowth was 1.9% per year between 5 and 15 years after 125I brachytherapy. In contrast to charged particles, the risk of late recurrence after 125I brachytherapy continued with increased follow-up.

Conclusions

There was a significantly higher late recurrence rate with 125I brachytherapy as compared with charged particle radiation. Although tumor enlargement 5 or more years after radiation can be the result of intratumor hemorrhage, in a patient treated with radioactive plaque, a late failure is a distinct possibility.

Section snippets

Materials and methods

We retrospectively reviewed all uveal melanoma patients we treated with helium ions (n = 348), protons (n = 199), or 125I brachytherapy (n = 449) between 1978 and 2000 to assess the occurrence rate of late failures, defined as those detected at least 5 years after treatment. All patients were evaluated and treated in a standardized manner and were part of ongoing phase I, II, and III treatment trials. The surgical, radiation planning, and follow-up protocols were identical throughout the period

Results

In irradiated uveal melanoma patients treated with brachytherapy, 58 of 449 uveal melanomas recurred locally with a mean interval between treatment and detection of recurrent growth of 3.6 years; the median was 2.9 years (range, 0.2–15.3 years). In contrast, after charged-particle therapy, intraocular tumor recurrence developed in 22 of 547 patients (15 of whom received helium ions and 7 of whom were treated with protons). The mean duration between treatment and the detection of intraocular

Discussion

In our experience with charged-particle uveal melanoma radiation, the longest time between radiation and detection of intraocular melanoma recurrence is approximately 5 years, with a mean interval of 1.6 years.14 Similar data has been published from Gragoudas9 and Gragoudas et al17 in Boston; they observed one failure 10 years after proton radiation. In contrast, we report 11 cases of late intraocular radiation failures after 125I brachytherapy between 5.5 to 15 years after treatment. The

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    Supported in part by a grant from the Tumori Foundation, San Francisco, California, and the University of California, San Francisco, California.

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