Palladium-103 Ophthalmic Plaque Radiation Therapy for Choroidal Melanoma: 400 Treated Patients

Purpose: To describe 18 years of experience with palladium-103 (¹⁰³Pd) ophthalmic plaque brachytherapy. Design: Retrospective case series. Participants: From 1990 to 2007, 400 patients were diagnosed with uveal melanoma, found negative for metastatic disease, and treated. Episcleral ¹⁰³Pd radiation was delivered to a mean apical radiation dose of 73.3 Gy over 5 to 7 continuous days. Intervention: Palladium-103 ophthalmic plaque brachytherapy. Main Outcome Measures: Patients were evaluated for local tumor control, visual acuity, radiation damage (retinopathy, optic neuropathy, cataract), and metastatic disease. Results: A total of 272 tumors (68%) were located at or posterior to the equator. There were 186 (46.5%) T1 tumors, 156 (39%) T2 tumors, 50 (12.5%) T3 tumors, and 8 (2%) T4 tumors. Patients were followed for a maximum of 205 months (mean, 51.1 months). Fourteen patients required secondary enucleation (5 for tumor growth and 9 for glaucoma pain control). The local control rate was 96.7%. Life table analysis of patients with 20/200 or better before treatment (n = 357) suggests that 79% and 69% are expected to retain that acuity for 5 and 10 years, respectively. Life table analysis demonstrates a probability that 92.7% and 86.6% of patients will be free of metastatic disease at 5 and 10 years, respectively. Conclusions: In a nonrandomized phase I clinical evaluation, ¹⁰³Pd ophthalmic plaque radiotherapy was used to treat 400 patients with uveal melanoma. In this series, results after ¹⁰³Pd ophthalmic plaque radiotherapy were superior to those reported for alternative forms of radiation. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.