Visual acuity, oncologic, and toxicity outcomes with Pd-103 vs. I-125 plaque treatment for choroidal melanoma

• Type of Material: Article
• Authors: Kirtesh Patel, Emory University; Roshan S. Prabhu, Carolinas Healthcare System; Jeffrey Switchenko, Emory University; Mudit Chowdhary, Emory University; Caroline Craven, Emory University; Pia Mendoza, Emory University; Hasan Danish, Emory University; Hans Grossniklaus, Emory University; Thomas Aaberg Sr., Emory University; Sahitya Reddy, Emory University; Elizabeth Butker, Emory University; Chris Bergstrom, Emory University; Ian Crocker, Emory University
• Language: English
• Date: 2017-03-03
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 American Brachytherapy Society
• Final Published Version (URL): http://dx.doi.org/10.1016/j.brachy.2017.01.012
• Title of Journal or Parent Work: Brachytherapy
• ISSN: 1538-4721
• Volume: 16
• Issue: 3
• Start Page: 646
• End Page: 653
• Keywords: Iodine; Radiology, Nuclear Medicine & Medical Imaging; Palladium; Science & Technology; COLLABORATIVE OCULAR MELANOMA; RECOMMENDATIONS; Life Sciences & Biomedicine; BRACHYTHERAPY; AAPM; Choroidal melanoma; Oncology; RADIOTHERAPY; DOSIMETRY; Episcleral plaque brachytherapy
• Research Categories: Health Sciences, Opthamology; Health Sciences, Oncology

Abstract

Purpose: To evaluate outcomes of choroidal melanoma patients treated with 125 I or 103 Pd plaque brachytherapy. Methods and Materials: From 1993 to 2012, our institution treated 160 patients with 103 Pd (56.1%) and 125 patients with 125 I (43.9%) plaque brachytherapy. Tumor outcomes, visual acuity (VA), and toxicity were compared. Multivariate analyses (MVAs) and propensity score analysis were used to help address differences in baseline characteristics. Results: Median followup was longer for 125 I patients, 52.7 vs. 43.5 months (p < 0.01). At baseline, 103 Pd patients had lower rates of VA worse than 20/200 (4.4% vs. 16%, p = 0.002), T3–T4 tumors (17.5% vs. 32.8%, p = 0.03), and transpupillary thermotherapy use (3.1% vs. 9.6%, p = 0.001). Both 103 Pd and 125 I provided > 90% 3-year overall survival and > 93% 5-year secondary enucleation-free survival. On MVA, radionuclide was not predictive for tumor outcomes. A higher percentage maintained vision better than 20/40 with 103 Pd (63% vs. 35%, p = 0.007) at 3 years. MVA demonstrated 103 Pd radionuclide (odds ratio [OR]: 2.12, p = 0.028) and tumor height ≤5 mm (OR: 2.78, p = 0.017) were associated with VA better than 20/40. Propensity score analysis matched 23 125 I with 107 103 Pd patients. 103 Pd continued to predict better VA at 3 years (OR: 8.10, p = 0.014). On MVA for the development of VA worse than 20/200 or degree of vision loss, radionuclide was not significant. Lower rates of radiation retinopathy were seen with 103 Pd than 125 I (3 years: 47.3% vs. 63.9%, p = 0.016), with radionuclide significant in MVA. Conclusions: Both 125 I and 103 Pd achieve excellent tumor control. An increased probability of long-term VA better than 20/40 and reduced risk of radiation retinopathy is associated with 103 Pd.