Low-dose radiation for juxtapapillary choroidal melanoma shows promising outcomes and safety

This retrospective case series examined outcomes of patients undergoing iodine-125 plaque brachytherapy for juxtapapillary choroidal melanoma.

Study design

The analysis included 47 patients with juxtapapillary choroidal melanoma treated with iodine-125 notched brachytherapy at a single center. The cohort was divided into apex low-dose (≤84.35 Gy) and high-dose (>85.35 Gy) groups.

Main outcome measures were time to distant failure, local failure, death, enucleation, radiation retinopathy, optic neuropathy and best corrected visual acuity.

Outcomes

Low-dose iodine-125 plaque brachytherapy (67.5–81 Gy at tumor apex) provided distant failure, local failure, death and enucleation rates comparable with those observed in the high-dose group. The authors demonstrated that there are potentially superior outcomes in terms of reduced radiation retinopathy and optic neuropathy for lower dose brachytherapy.

Limitations

Patients in this study were treated in 1 center and the results may not represent all institutions. The study was also limited by its retrospective nature and small sample size. Finally, the analysis was performed prior to routine fine needle aspiration biopsy for genetic profiling—thus, the authors were unable to examine the correlation between genetic mutations and patient outcomes.

Clinical significance

This was the first study to demonstrate that survival and tumor control are not compromised by low-dose brachytherapy. The low-dose group had similar 5-year tumor control rates as patients with juxtapapillary melanoma in the COMS (Collaborative Ocular Melanoma Study) trial.  A multi-institutional study would provide more insight into dose recommendations for juxtapapillary choroidal melanoma.