Brachytherapy of Choroidal Melanomas Less Than 10 mm in Largest Basal Diameter

Purpose To compare tumor control, vision, and complications between patients with a choroidal melanoma of <10 mm in largest basal diameter (LBD) irradiated 10-mm or 15-mm ruthenium plaques. Design Retrospective, comparative case series. Participants One hundred sixty-four consecutive LBD, 76 88 treated the plaque, respectively, from 1998–2014 national ocular oncology service. Methods Diagnosis was based on growth high-risk characteristics. The apical dose 100 to 120 Gy aiming deliver ≥250 sclera. Plaque positioning modeled retrospectively. An increase ≥0.3 thickness ≥0.5 LBD indicated local recurrence. Outcomes were compared cumulative incidence analysis Cox regression. Median follow-up time for still alive 8.4 years. Main Outcome Measures Recurrence rate, low blindness, radiation maculopathy, optic neuropathy. Results Melanomas plaque smaller (median thickness, 1.9 vs. 2.6 mm; 7.1 8.6 mm) located closer foveola (median, 2.0 2.8 than those (P < 0.001). 2 plaques provided safety margin 43% versus 40% eyes, no guard 17% 33%, did not entirely cover mainly close disc 32% 18% respectively = 0.052). recurrence comparable (13% 15% at 10 years; P 0.31) associated (hazard ratio [HR], 2.81 margin; 0.041). At 5 years, vision 14% 24%, that blindness 3% 6%. Distance loss both levels (HR, 0.65 per 1 0.68 ≤ 0.001 0.004). maculopathy (19% years), whereas neuropathy tended be higher (2% 9%; 0.054). Conclusions contributes better visual preservation, particularly tumors fovea, without may therefore preferable plaque.