Cancer Res Treat.  2018 Jan;50(1):138-147. 10.4143/crt.2016.391.

Ruthenium-106 Brachytherapy with or without Additional Local Therapy Shows Favorable Outcome for Variable-Sized Choroidal Melanomas in Korean Patients

• Cho Y
• Chang JS
• Yoon JS
• Lee SC
• Kim YB
• Kim JH
• Keum KC

• KMID: 2403483
• DOI: http://doi.org/10.4143/crt.2016.391

Abstract

PURPOSE
The purpose of this study was to report clinical outcomes of ruthenium-106 (106Ru) brachytherapy with or without additional local therapy for choroidal melanomas in Korean patients.
MATERIALS AND METHODS
A total of 88 patients diagnosed with choroidal melanomas were treated with 106Ru brachytherapy between 2006 and 2012. Patients were divided into two groups according to their tumor height: a large group (≥ 6 mm, n=50) and a small group (< 6 mm, n=38). Most patients in the large group received combined therapy with local excision and/or transpupillary thermotherapy. In general, 85-95 Gy was administered to the apex of the tumor, while 100 Gy was administered to the point 2-6 mm from the outer surface of the sclera for patients undergoing combined therapy.
RESULTS
The median follow-up duration was 30 months. The 3-year local control rate was significantly higher in the small group than in the large group (94% vs. 70%, p=0.047). The free from distant metastasis (FFDM) rate and the overall survival (OS) rate were also higher in patients in the small group (3-year FFDM, 97% vs. 76%; p=0.031 and 3-year OS, 97% vs. 72%; p=0.036). A total of 13 patients underwent enucleation. The eye-preservation rate was also higher in the small group (3-year eye-preservation rate, 94% vs. 70%; p=0.050), and tumor height was a significant prognostic factor for eye-preservation.
CONCLUSION
106Ru brachytherapy showed favorable outcomes in small choroidal melanomas in Korean patients. Although additional local treatment could improve eye-preservation rate for large tumors, other strategies should be considered for disease control.

Keyword

Uveal melanoma; Brachytherapy; Ruthenium radioisotopes

MeSH Terms

Brachytherapy*
Choroid*
Follow-Up Studies
Humans
Hyperthermia, Induced
Melanoma*
Neoplasm Metastasis
Ruthenium Radioisotopes
Sclera
Ruthenium Radioisotopes

Figure

• 

  Fig. 1. Treatment flow diagram. F/U, follow-up; TTT, transpupillary thermotherapy.

• 

  Fig. 2. Local control of all patients (A) and two groups (B).

• 

  Fig. 3. Free from distant metastasis (A) and overall survival (B) curves of two groups.

• 

  Fig. 4. Eye-preservation rate of all patients (A) and two groups (B).

Reference

References

1. Kwon HJ, Ko JS, Kim M, Lee CS, Lee SC. Prognosis of choroidal melanoma and the result of ruthenium brachytherapy combined with transpupillary thermotherapy in Korean patients. Br J Ophthalmol. 2013; 97:653–8.

2. Diener-West M, Earle JD, Fine SL, Hawkins BS, Moy CS, Reynolds SM, et al. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings. COMS Report No. 18. Arch Ophthalmol. 2001; 119:969–82.

3. Diener-West M, Earle JD, Fine SL, Hawkins BS, Moy CS, Reynolds SM, et al. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, II: characteristics of patients enrolled and not enrolled. COMS Report No. 17. Arch Ophthalmol. 2001; 119:951–65.

4. Collaborative Ocular Melanoma Study Group. Ten-year follow-up of fellow eyes of patients enrolled in Collaborative Ocular Melanoma Study randomized trials: COMS report no. 22. Ophthalmology. 2004; 111:966–76.

5. Lommatzsch PK, Werschnik C, Schuster E. Long-term follow-up of Ru-106/Rh-106 brachytherapy for posterior uveal melanoma. Graefes Arch Clin Exp Ophthalmol. 2000; 238:129–37.

6. Potter R, Janssen K, Prott FJ, Widder J, Haverkamp U, Busse H, et al. Ruthenium-106 eye plaque brachytherapy in the conservative treatment of uveal melanoma: evaluation of 175 patients treated with 150 Gy from 1981-1989. Front Radiat Ther Oncol. 1997; 30:143–9.

7. Seregard S, aft Trampe E, Lax I, Kock E, Lundell G. Results following episcleral ruthenium plaque radiotherapy for posterior uveal melanoma. The Swedish experience. Acta Ophthalmol Scand. 1997; 75:11–6.

8. Shields CL, Bianciotto C, Rudich D, Materin MA, Ganguly A, Shields JA. Regression of uveal melanoma after plaque radiotherapy and thermotherapy based on chromosome 3 status. Retina. 2008; 28:1289–95.

9. Lommatzsch PK, Weise B, Ballin R. Optimization of irradiation time in the treatment of malignant melanoma of the choroid with beta applicators (106Ru/106Rh). Klin Monbl Augenheilkd. 1986; 189:133–40.

10. Yarovoy AA, Magaramov DA, Bulgakova ES. The comparison of ruthenium brachytherapy and simultaneous transpupillary thermotherapy of choroidal melanoma with brachytherapy alone. Brachytherapy. 2012; 11:224–9.

11. Shields CL, Cater J, Shields JA, Chao A, Krema H, Materin M, et al. Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: tumor control and treatment complications in 270 consecutive patients. Arch Ophthalmol. 2002; 120:933–40.

12. Lommatzsch PK. Results after beta-irradiation (106Ru/106Rh) of choroidal melanomas: 20 years’ experience. Br J Ophthalmol. 1986; 70:844–51.

13. Hawkins BS; Collaborative Ocular Melanoma Study Group. The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma: IV. Ten-year mortality findings and prognostic factors. COMS report number 24. Am J Ophthalmol. 2004; 138:936–51.

14. Krema H, Heydarian M, Beiki-Ardakani A, Weisbrod D, Xu W, Simpson ER, et al. A comparison between ¹²⁵Iodine brachytherapy and stereotactic radiotherapy in the management of juxtapapillary choroidal melanoma. Br J Ophthalmol. 2013; 97:327–32.

15. Kaiserman N, Kaiserman I, Hendler K, Frenkel S, Pe’er J. Ruthenium-106 plaque brachytherapy for thick posterior uveal melanomas. Br J Ophthalmol. 2009; 93:1167–71.

16. Mashayekhi A, Shields CL, Rishi P, Atalay HT, Pellegrini M, McLaughlin JP, et al. Primary transpupillary thermotherapy for choroidal melanoma in 391 cases: importance of risk factors in tumor control. Ophthalmology. 2015; 122:600–9.

17. Seregard S, Landau I. Transpupillary thermotherapy as an adjunct to ruthenium plaque radiotherapy for choroidal melanoma. Acta Ophthalmol Scand. 2001; 79:19–22.

18. Kreusel KM, Bechrakis N, Riese J, Krause L, Wachtlin J, Foerster MH. Combined brachytherapy and transpupillary thermotherapy for large choroidal melanoma: tumor regression and early complications. Graefes Arch Clin Exp Ophthalmol. 2006; 244:1575–80.

19. Augsburger JJ, Schneider S, Narayana A, Breneman JC, Aron BS, Barrett WL, et al. Plaque radiotherapy for choroidal and ciliochoroidal melanomas with limited nodular extrascleral extension. Can J Ophthalmol. 2004; 39:380–7.

20. Damato B, Patel I, Campbell IR, Mayles HM, Errington RD. Visual acuity after Ruthenium¹⁰⁶ brachytherapy of choro-idal melanomas. Int J Radiat Oncol Biol Phys. 2005; 63:392–400.

21. Verschueren KM, Creutzberg CL, Schalij-Delfos NE, Ketelaars M, Klijsen FL, Haeseker BI, et al. Long-term outcomes of eye-conserving treatment with Ruthenium¹⁰⁶ brachytherapy for choroidal melanoma. Radiother Oncol. 2010; 95:332–8.

22. Lommatzsch PK, Alberti W, Lommatzsch R, Rohrwacher F. Radiation effects on the optic nerve observed after brachytherapy of choroidal melanomas with 106Ru/106Rh plaques. Graefes Arch Clin Exp Ophthalmol. 1994; 232:482–7.

23. Sakamoto T, Sakamoto M, Yoshikawa H, Hata Y, Ishibashi T, Ohnishi Y, et al. Histologic findings and prognosis of uveal malignant melanoma in japanese patients. Am J Ophthalmol. 1996; 121:276–83.

24. Bensoussan E, Thariat J, Maschi C, Delas J, Schouver ED, Herault J, et al. Outcomes after proton beam therapy for large choroidal melanomas in 492 Patients. Am J Ophthalmol. 2016; 165:78–87.

25. Konstantinidis L, Roberts D, Errington RD, Kacperek A, Heimann H, Damato B. Transpalpebral proton beam radiotherapy of choroidal melanoma. Br J Ophthalmol. 2015; 99:232–5.

26. Hawkins BS. Collaborative ocular melanoma study randomized trial of I-125 brachytherapy. Clin Trials. 2011; 8:661–73.

27. Danielli R, Ridolfi R, Chiarion-Sileni V, Queirolo P, Testori A, Plummer R, et al. Ipilimumab in pretreated patients with metastatic uveal melanoma: safety and clinical efficacy. Cancer Immunol Immunother. 2012; 61:41–8.