Comparative outcomes and toxicities for ruthenium-106 versus palladium-103 in the treatment of choroidal melanoma

• Type of Material: Article
• Authors: Hasan Danish, Emory University; Matthew J. Ferris, Emory University; Ehsan Balagamwala, Cleveland Clinic; Jeffrey Switchenko, Emory University; Kirtesh Patel, Emory University; Maria Choudhary, Cleveland Clinic; Caroline Craven, Emory University; Pia Mendoza, Emory University; John Suh, Cleveland Clinic; Chris Bergstrom, Emory University; Hans Grossniklaus, Emory University; Thomas Aaberg Sr., Emory University; Arun Singh, Cleveland Clinic; Ian Crocker, Emory University; Mohammad Khan, Emory University
• Language: English
• Date: 2018-04-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/CMR.0000000000000420
• Title of Journal or Parent Work: Melanoma Research
• ISSN: 0960-8931
• Volume: 28
• Issue: 2
• Start Page: 120
• End Page: 125
• Grant/Funding Information: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: visual acuity preservation; VISUAL-ACUITY; COMS RANDOMIZED TRIAL; radioisotope selection; Dermatology; UVEAL MELANOMA; Life Sciences & Biomedicine; COLLABORATIVE OCULAR MELANOMA; PLAQUE BRACHYTHERAPY; Medicine, Research & Experimental; Research & Experimental Medicine; choroidal melanoma; ruthenium; radiation toxicity; I-125; SURVIVAL; IODINE-125 BRACHYTHERAPY; palladium; Oncology; Science & Technology; RADIOTHERAPY; plaque brachytherapy; RUTHENIUM PLAQUE
• Research Categories: Health Sciences, Toxicology; Health Sciences, Oncology; Biology, Biostatistics

Abstract

For the treatment of choroidal melanoma, palladium-103 ( 103 Pd) and ruthenium-106 ( 106 Ru) plaque brachytherapy shows reduced toxicity compared with the historical standard iodine-125. No report has directly compared the clinical outcomes between 103 Pd and 106 Ru, and the reasons for the selection of one over the other remain purely theoretical. Patients with choroidal melanoma with apical tumor height up to 5 mm were included. Patients from Emory University were treated with 103 Pd between 1993 and 2012. Patients from Cleveland Clinic were treated with 106 Ru between 2005 and 2010. Medical records were retrospectively reviewed. We compared post-treatment visual acuity (VA), toxicity, and oncologic outcomes. 103 Pd patients (n = 124) and 106 Ru patients (n = 42) had a median follow-up of 4.2 and 5.0 years, respectively. Radiation retinopathy-free survival was similar for both radioisotopes, but 106 Ru had lower grades of retinopathy (P = 0.006). 103 Pd was associated with worse VA preservation (≥20/40) by year 3 (odds ratio: 3.8; 95% confidence interval: 1.01-14.31, P = 0.048). 103 Pd was associated with higher distant metastases-free survival (DMFS) in multivariate analysis (hazard ratio: 0.10; 95% confidence interval: 0.02-0.38; P < 0.001). 106 Ru had lower grades of radiation retinopathy and improved long-term VA preservation, but also inferior DMFS, compared with 103 Pd. Because of the inherent limitations of a retrospective analysis, the significance of the inferior DMFS for 106 Ru remains unclear, although the suggestion of a slight inferiority in terms of DMFS for 106 Ru is consistent with the other limited literature. On the basis of this study, we believe that both radioisotopes remain appropriate for the treatment of small choroidal melanomas up to 5 mm in apical height.