Melanoma: Quivey JM

Nag S, Quivey JM, Earle JD, Followill D, Fontanesi J, Finger PT, Anonymous00040. · Department of Radiation Oncology, Ohio State University, Columbus, OH 43210, USA. · Int J Radiat Oncol Biol Phys. · Pubmed #12738332 No free full text.

Abstract: PURPOSE: This article presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with choroidal melanomas. METHODS: Members of the ABS with expertise in choroidal melanoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. RESULTS: Episcleral plaque brachytherapy is a complex procedure and should only be undertaken in specialized medical centers with expertise in this sophisticated treatment program. Recommendations were made for patient selection, techniques, dose rates, and dosages. Most patients with very small uveal melanomas (<2.5 mm height and <10 mm in largest basal dimension) should be observed for tumor growth before treatment. Patients with a clinical diagnosis of medium-sized choroidal melanoma (between 2.5 and 10 mm in height and <16 mm basal diameter) are candidates for episcleral plaques if the patient is otherwise healthy and without metastatic disease. A histopathologic verification is not required. Small melanomas may be candidates if there is documented growth; some patients with large melanomas (>10 mm height or >16 mm basal diameter) may also be candidates. Patients with large tumors or with tumors at peripapillary and macular locations have a poorer visual outcome and lower local control that must be taken into account in the patient decision-making process. Patients with gross extrascleral extension, ring melanoma, and tumor involvement of more than half of the ciliary body are not suitable for plaque therapy. For plaque fabrication, the ophthalmologist must provide the tumor size (including basal diameters and tumor height) and a detailed fundus diagram. The ABS recommends a minimum tumor (125)I dose of 85 Gy at a dose rate of 0.60-1.05 Gy/h using AAPM TG-43 formalism for the calculation of dose. NRC or state licensing guidelines regarding procedures for handling of radioisotopes must be followed. CONCLUSIONS: Brachytherapy represents an effective means of treating patients with choroidal melanomas. Guidelines are established for the use of brachytherapy in the treatment of choroidal melanomas. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose reporting policies. These guidelines will be modified as further clinical results become available.

Char DH, Kroll S, Phillips TL, Quivey JM. · Tumori Foundation, San Francisco, California. Department of Radiation Oncology, University of California, San Francisco, California 94114, USA. · Ophthalmology. · Pubmed #12359605 No free full text.

Abstract: OBJECTIVE: To evaluate late (more than 5 years) radiation failures after uveal melanoma treatment. DESIGN: Comparison of three retrospective, interventional, partially randomized case series. PARTICIPANTS: Nine hundred ninety-six patients who were treated in several phase I, II, and III trials of uveal melanoma radiation. MAIN OUTCOME MEASURES: Follow-up period, treatment history, recurrence rates, type of recurrence, and mortality associated with late local recurrences. RESULTS: Eleven of 996 irradiated uveal melanoma patients experienced intraocular recurrence more than 5 years after radiation. All 11 of these patients were treated with iodine 125 ((125)I) brachytherapy. Late recurrences were detected between 5.5 to 15.3 years after treatment. These patients did not have either high-risk clinical parameters (thin, posterior tumors in proximity to the optic nerve) or radiation dosimetry characteristics (low dose-delivery radiation) associated with a known increased risk for tumor recurrence after radioactive plaques. The annualized incidence rate for regrowth was 1.9% per year between 5 and 15 years after (125)I brachytherapy. In contrast to charged particles, the risk of late recurrence after (125)I brachytherapy continued with increased follow-up. CONCLUSIONS: There was a significantly higher late recurrence rate with (125)I brachytherapy as compared with charged particle radiation. Although tumor enlargement 5 or more years after radiation can be the result of intratumor hemorrhage, in a patient treated with radioactive plaque, a late failure is a distinct possibility.