Skip to main content
NCBI home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1996 Aug;80(8):732–739. doi: 10.1136/bjo.80.8.732

Radiation related complications after ruthenium plaque radiotherapy of uveal melanoma.

P Summanen 1, I Immonen 1, T Kivelä 1, P Tommila 1, J Heikkonen 1, A Tarkkanen 1
PMCID: PMC505591  PMID: 8949719

Abstract

AIMS/BACKGROUND: To analyse radiation related complications and secondary enucleation after irradiation of malignant uveal melanoma with ruthenium-106 plaques. METHODS: A series of 100 consecutive eyes irradiated in 1981-91 was analysed using the life table method and the Cox proportional hazards model. The median apical and scleral tumour dose was 100 Gy (range 15-200 Gy) and 1000 Gy (range 200-1200 Gy), respectively. The median follow up time was 2.8 and 2.0 years (range 1 month to 10 years) for anterior and posterior segment complications, respectively. RESULTS: The 3 and 5 year probabilities of being without radiation cataract were 73% and 63%, without neovascular glaucoma 91% and 81%, without vitreous haemorrhage 83% and 74%, without radiation maculopathy 85% and 70%, and without radiation optic neuropathy 90% and 88%, respectively. The risk of radiation cataract was highest with large tumour size (T1 + T2 v T3, p = 0.0027; height < or = 5 v > 5 mm, p = 0.029; largest basal diameter (LBD) < or = 15 v > 15 mm, p < 0.0001) and location of anterior tumour margin anterior v posterior to the equator (p = 0.0003); the risk of neovascular glaucoma with large size (T1 + T2 v T3, p = 0.039; LBD < or = 15 mm v 15 mm, p = 0.021); and the risk of maculopathy and optic neuropathy with proximity of the posterior tumour margin to the fovea and the optic disc (< or = 1.5 v > 1.5 mm; p = 0.030 and p = 0.0004, respectively). In Cox's multivariate analysis the strongest risk indicator for radiation cataract (RR 1.5, 95% CI 1.4-1.6) and vitreous haemorrhage (RR 1.6, 95% CI 1.4-1.8) was the height of the tumour; for neovascular glaucoma the TNM class (RR 6.2, 95% CI 2.7-13.8); for radiation maculopathy location of posterior tumour margin within 2 mm from the fovea (RR 3.4, 95% CI 2.0-6.0); and for radiation optic neuropathy location of tumour margin within 1 DD of the optic disc (RR 6.1, 95% CI 3.0-12.4). The 3 and 5 year probabilities of avoiding enucleation were 92% and 85%, respectively. Ten eyes were enucleated--six because of recurrent tumour growth, three because of treatment complications, and one because of mistakenly suspected extraocular growth. CONCLUSION: The results suggest that the frequency of radiation related complications after ruthenium brachytherapy of uveal melanoma is acceptable, in particular as regard irradiation of small and medium sized tumours for which ruthenium therapy generally is recommended.

Full text

PDF
732

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brown G. C., Shields J. A., Sanborn G., Augsburger J. J., Savino P. J., Schatz N. J. Radiation optic neuropathy. Ophthalmology. 1982 Dec;89(12):1489–1493. doi: 10.1016/s0161-6420(82)34612-6. [DOI] [PubMed] [Google Scholar]
  2. Brown G. C., Shields J. A., Sanborn G., Augsburger J. J., Savino P. J., Schatz N. J. Radiation retinopathy. Ophthalmology. 1982 Dec;89(12):1494–1501. doi: 10.1016/s0161-6420(82)34611-4. [DOI] [PubMed] [Google Scholar]
  3. Char D. H., Castro J. R. Helium ion therapy for choroidal melanoma. Arch Ophthalmol. 1982 Jun;100(6):935–938. doi: 10.1001/archopht.1982.01030030943008. [DOI] [PubMed] [Google Scholar]
  4. Char D. H., Castro J. R., Kroll S. M., Irvine A. R., Quivey J. M., Stone R. D. Five-year follow-up of helium ion therapy for uveal melanoma. Arch Ophthalmol. 1990 Feb;108(2):209–214. doi: 10.1001/archopht.1990.01070040061031. [DOI] [PubMed] [Google Scholar]
  5. Char D. H., Castro J. R., Quivey J. M., Phillips T. L., Irvine A. R., Stone R. D., Kroll S. Uveal melanoma radiation. 125I brachytherapy versus helium ion irradiation. Ophthalmology. 1989 Dec;96(12):1708–1715. [PubMed] [Google Scholar]
  6. Char D. H., Lonn L. I., Margolis L. W. Complications of cobalt plaque therapy of choroidal malanomas. Am J Ophthalmol. 1977 Oct;84(4):536–541. doi: 10.1016/0002-9394(77)90448-2. [DOI] [PubMed] [Google Scholar]
  7. Decker M., Castro J. R., Linstadt D. E., Char D., Petti P. L., Quivey J. M., Ahn D. Ciliary body melanoma treated with helium particle irradiation. Int J Radiat Oncol Biol Phys. 1990 Aug;19(2):243–247. doi: 10.1016/0360-3016(90)90530-w. [DOI] [PubMed] [Google Scholar]
  8. Foerster M. H., Bornfeld N., Schulz U., Wessing A., Meyer-Schwickerath G. Complications of local beta radiation of uveal melanomas. Graefes Arch Clin Exp Ophthalmol. 1986;224(4):336–340. doi: 10.1007/BF02150026. [DOI] [PubMed] [Google Scholar]
  9. Gragoudas E. S., Seddon J., Goitein M., Verhey L., Munzenrider J., Urie M., Suit H. D., Blitzer P., Koehler A. Current results of proton beam irradiation of uveal melanomas. Ophthalmology. 1985 Feb;92(2):284–291. doi: 10.1016/s0161-6420(85)34058-7. [DOI] [PubMed] [Google Scholar]
  10. Guyer D. R., Mukai S., Egan K. M., Seddon J. M., Walsh S. M., Gragoudas E. S. Radiation maculopathy after proton beam irradiation for choroidal melanoma. Ophthalmology. 1992 Aug;99(8):1278–1285. doi: 10.1016/s0161-6420(92)31832-9. [DOI] [PubMed] [Google Scholar]
  11. Hillis A. Improving reporting of follow-up data. Am J Ophthalmol. 1982 Feb;93(2):250–253. doi: 10.1016/0002-9394(82)90424-x. [DOI] [PubMed] [Google Scholar]
  12. Kleineidam M., Augsburger J. J., Hernandez C., Glennon P., Brady L. W. Cataractogenesis after Cobalt-60 eye plaque radiotherapy. Int J Radiat Oncol Biol Phys. 1993 Jul 15;26(4):625–630. doi: 10.1016/0360-3016(93)90279-5. [DOI] [PubMed] [Google Scholar]
  13. Linstadt D., Castro J., Char D., Decker M., Ahn D., Petti P., Nowakowski V., Quivey J., Phillips T. L. Long-term results of helium ion irradiation of uveal melanoma. Int J Radiat Oncol Biol Phys. 1990 Sep;19(3):613–618. doi: 10.1016/0360-3016(90)90487-5. [DOI] [PubMed] [Google Scholar]
  14. Lommatzsch P. K., 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 Aug;232(8):482–487. doi: 10.1007/BF00195358. [DOI] [PubMed] [Google Scholar]
  15. Lommatzsch P. K. Results after beta-irradiation (106Ru/106Rh) of choroidal melanomas: 20 years' experience. Br J Ophthalmol. 1986 Nov;70(11):844–851. doi: 10.1136/bjo.70.11.844. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Lommatzsch P. K. beta-Irradiation of choroidal melanoma with 106Ru/106Rh applicators. 16 Years' experience. Arch Ophthalmol. 1983 May;101(5):713–717. doi: 10.1001/archopht.1983.01040010713002. [DOI] [PubMed] [Google Scholar]
  17. Lommatzsch P. Treatment of choroidal melanomas with 106Ru/106Rh beta-ray applicators. Surv Ophthalmol. 1974 Sep-Oct;19(2):85–100. [PubMed] [Google Scholar]
  18. Macfaul P. A., Bedford M. A. Ocular complications after therapeutic irradiation. Br J Ophthalmol. 1970 Apr;54(4):237–247. doi: 10.1136/bjo.54.4.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Meecham W. J., Char D. H., Kroll S., Castro J. R., Blakely E. A. Anterior segment complications after helium ion radiation therapy for uveal melanoma. Radiation cataract. Arch Ophthalmol. 1994 Feb;112(2):197–203. doi: 10.1001/archopht.1994.01090140073026. [DOI] [PubMed] [Google Scholar]
  20. Quivey J. M., Char D. H., Phillips T. L., Weaver K. A., Castro J. R., Kroll S. M. High intensity 125-iodine (125I) plaque treatment of uveal melanoma. Int J Radiat Oncol Biol Phys. 1993 Jul 15;26(4):613–618. doi: 10.1016/0360-3016(93)90277-3. [DOI] [PubMed] [Google Scholar]
  21. Seddon J. M., Gragoudas E. S., Egan K. M., Glynn R. J., Munzenrider J. E., Austin-Seymour M., Goitein M., Verhey L., Urie M., Koehler A. Uveal melanomas near the optic disc or fovea. Visual results after proton beam irradiation. Ophthalmology. 1987 Apr;94(4):354–361. doi: 10.1016/s0161-6420(87)33439-6. [DOI] [PubMed] [Google Scholar]
  22. Seigel D. Analysis of follow-up data. Arch Ophthalmol. 1985 May;103(5):647–648. doi: 10.1001/archopht.1985.01050050039011. [DOI] [PubMed] [Google Scholar]
  23. Stallard H. B. Radiotherapy for malignant melanoma of the choroid. Br J Ophthalmol. 1966 Mar;50(3):147–155. doi: 10.1136/bjo.50.3.147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Summanen P., Immonen I., Heikkonen J., Tommila P., Laatikainen L., Tarkkanen A. Survival of patients and metastatic and local recurrent tumor growth in malignant melanoma of the uvea after ruthenium plaque radiotherapy. Ophthalmic Surg. 1993 Feb;24(2):82–90. [PubMed] [Google Scholar]
  25. Summanen P., Immonen I., Kivelä T., Tommila P., Heikkonen J., Tarkkanen A. Visual outcome of eyes with malignant melanoma of the uvea after ruthenium plaque radiotherapy. Ophthalmic Surg Lasers. 1995 Sep-Oct;26(5):449–460. [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES