Plaque radiotherapy may treat circumpapillary choroidal melanoma

Custom-designed plaque radiotherapy may offer some patients a potential treatment for circumpapillary choroidal melanoma, according to a study by researchers in Philadelphia. "We found satisfactory local tumor control, and globe retention was achieved in 75% of eyes with more than 5 months follow-up," the study authors said.

Mandeep S. Sagoo, MB, PhD, MRCOphth, and colleagues reviewed outcomes for 37 consecutive circumpapillary choroidal melanoma patients treated with plaque radiotherapy at an average age of 69 years. In all cases, the tumors touched and encircled the optic disc for 360°, according to the study, published in the September issue of Archives of Ophthalmology.

Surgeons used iodine 125 and a notched plaque design for radiotherapy in 34 patients (92%). Planned adjunctive treatment included transpupillary thermotherapy in 17 patients and argon laser photocoagulation in six patients, according to the study.

Of 28 eyes with more than 5 months follow-up, treatment complications included nonproliferative retinopathy in 11 eyes (39%), proliferative retinopathy in seven eyes (25%), maculopathy in seven eyes (25%), papillopathy in nine eyes (32%), neovascular glaucoma in five eyes (18%) and vitreous hemorrhage in 13 eyes (46%), the authors reported.

In addition, two of 13 eyes (15%) with persistent vitreous hemorrhage required pars plana vitrectomy, they noted.

Overall, 13 eyes (62%) had a long-term visual acuity of 20/200 or worse and 12 eyes (57%) lost more than five lines of visual acuity, "excluding seven cases (25%) in which enucleation was necessary," the authors reported.

Four cases (14%) experienced disease recurrence, three of which underwent enucleation and one was treated with transpupillary thermotherapy. Systemic metastasis also occurred in one patient (4%), but no melanoma-specific deaths occurred, according to the study.