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Author Notes:

Corresponding author. Department of Radiation Oncology, Emory University, 1365 Clifton Road, NE, Atlanta, GA 30322. Tel.: 404-778-3473; fax: 404-778-4139. krpate8@emory.edu

Conflict of interest: None.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Radiology, Nuclear Medicine & Medical Imaging
  • Choroidal melanoma
  • Episcleral plaque brachytherapy
  • Palladium
  • Iodine
  • COLLABORATIVE OCULAR MELANOMA
  • BRACHYTHERAPY
  • DOSIMETRY
  • AAPM
  • RECOMMENDATIONS
  • RADIOTHERAPY

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

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Journal Title:

Brachytherapy

Volume:

Volume 16, Number 3

Publisher:

, Pages 646-653

Type of Work:

Article | Post-print: After Peer Review

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.

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© 2017 American Brachytherapy Society

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