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Plaque therapy achieves good local control in small choroidal melanomas
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TORONTO — Palladium-103 plaque therapy is a reasonable treatment for small choroidal melanomas, achieving excellent local control of a 1% metastatic rate, a speaker said here.
Speaking at theat the American Society of Retina Specialists meeting here, Paul T. Finger, MD, FACS, reported a study of 91 patients with small choroidal melanomas – maximum base diameter of 10 mm and maximum height of 2.5 mm – treated with palladium-103 plaque therapy and followed up for 54 months. Only one patient’s disease metastasized.
Paul T. Finger
Patients undergo a whole body computed tomography scan before treatment to look for other primary tumors, but after plaque therapy, targeted imaging studies are done periodically to look for areas of likely metastasis.
“Once a patient is treated, we use the liver kind of as the canary in the coal mine,” Finger said. “You know it is going to show up there first, so we do imaging studies every 6 months in the first 3 years and then once a year after that.”
Finger said that most of the patients’ lesions were orange pigmented, had subretinal fluid and had a thickness of 2 mm or greater.
Vision improved in 20.9% of patients, remained unchanged in 44%, and decreased in 38.5% of patients. Vision loss was related to pre-existing foveal detachment in one patient, radiation maculopathy or optic neuropathy in 28 patients, exudative macular degeneration in two patients and secondary enucleation in one patient.
“Larger tumors are more likely to have patient metastatic disease. So it is reasonable to think that if we treat smaller tumors, we just may be saving lives,” he said.
Disclosure: Finger declares that support for this study was given by the Eye Cancer Foundation Inc.