Uveal Melanoma with Thickness between 4 and 6 mm Treated with two Different Radioisotopes (I125 or Ru106): Single Institution Experience

OBJECTIVEThis study aims to evaluate if a disease thickness cut-off of 5 mm can be considered the best choice toselect gamma emitter sources, as 125I, for the treatment of uveal melanomas.METHODSThe records of patients affected by primary uveal melanoma and treated in our institutional IOC (InterventionalOncology Center) from December 2006 to December 2016 were retrospectively reviewed.Only patients with a disease thickness between 4 mm and 6 mm treated with 106Ru or 125I plaque wereconsidered for this analysis.RESULTSBetween December 2006 and December 2016, 107 patients (107 eyes) with UM received brachytherapytreatment with tumor thickness between 4 and 6 mm. Nine patients developed local recurrence whileseven patients had distant metastases. No statistically significant difference (p=0.36) was observed betweenthe two groups (125I versus 106Ru) concerning DFS. Five patients treated with 125I (19.2%) experiencedradiation maculopathy; this finding is noteworthy because this toxicity was experienced by 21patients treated with 106Ru (25.9%).CONCLUSIONIn this study, we report that the use of 125I seeds for UM with a thickness between 5 mm and 6 mm isnot associated with a statistically significant increased risk of radiation maculopathy. It is desirable thatfurther multicentric investigations may help to confirm the results of our study.

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1. Virgili G, Gatta G, Ciccolallo L, Capocaccia R, Biggeri A, Crocetti E, et al. Incidence of uveal melanoma in Europe. Ophthalmology 2007;114(12):2309–15.
2. Jensen AW, Petersen IA, Kline RW, Stafford SL, Schomberg PJ, Robertson DM. Radiation complications and tumor control after 125I plaque brachytherapy for ocular melanoma. Int J Radiat Oncol Biol Phys 2005;63(1):101–8.
3. Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol 2006;124(12):1684–93.
4. Diener-West M, Earle JD, Fine SL, Hawkins BS, Moy CS, Reynolds SM, et al. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings. COMS Report No. 18. Arch Ophthalmol 2001;119(7):969–82.
5. Sieving PA. Fifteen years of work: the COMS outcomes for medium-sized choroidal melanoma. Arch Ophthalmol 2001;119(7):1067–8.
6. Pagliara MM, Tagliaferri L, Azario L, Lenkowicz J, Lanza A, Autorino R, et al. Ruthenium brachytherapy for uveal melanomas: Factors affecting the development of radiation complications. Brachytherapy 2018;17(2):432–8.
7. Wen JC, McCannel TA. Treatment of radiation retinopathy following plaque brachytherapy for choroidal melanoma. Curr Opin Ophthalmol 2009;20(3):200–4.
8. Tagliaferri L, Pagliara MM, Masciocchi C, Scupola A, Azario L, Grimaldi G, et al. Nomogram for predicting radiation maculopathy in patients treated with Ruthenium- 106 plaque brachytherapy for uveal melanoma. J Contemp Brachytherapy 2017;9(6):540–7.
9. El Saghir NS, Keating NL, Carlson RW, Khoury KE, Fallowfield L. Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide. Am Soc Clin Oncol Educ Book 2014;e461–e6.
10. Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev 2016;42:56–72.
11. American Brachytherapy Society - Ophthalmic Oncology Task Force. The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma. Brachytherapy 2014;13(1):1–14.
12. Blasi MA, Pagliara MM, Tagliaferri L, Caputo CG, Villano A, Balestrazzi E. Brachytherapy with Iodine 125 or Ruthenium 106 for treatment of choroidal melanomas measuring 5-7 mm in thickness. Investigative Ophthalmology & Visual Science March 2012;53:3404.
13. Tarmann L, Wackernagel W, Ivastinovic D, Schneider M, Winkler P, Langmann G. Tumor parameters predict the risk of side effects after ruthenium-106 plaque brachytherapy of uveal melanomas. PLoS One 2017;12(8):e0183833.
14. Tagliaferri L, Pagliara MM, Boldrini L, Caputo CG, Azario L, Campitelli M, et al. INTERACTS (INTErventional Radiotherapy ACtive Teaching School) guidelines for quality assurance in choroidal melanoma interventional radiotherapy (brachytherapy) procedures. J Contemp Brachytherapy 2017;9:287–95.
15. Kovács G, Tagliaferri L, Valentini V. Is an Interventional Oncology Center an advantage in the service of cancer patients or in the education? The Gemelli Hospital and INTERACTS experience. J Contemp Brachytherapy 2017;9(6):497–8.
16. Piermattei A, Grimaldi L, D’Onofrio G, Cilla S, Viola P, Craus M, et al. In-vivo portal dosimetry by an ionization chamber. Phys Med 2005;21(4):143–52.
17. Melia BM, Abramson DH, Albert DM, Boldt HC, Earle JD, Hanson WF, et al. Collaborative ocular melanoma study (COMS) randomized trial of I-125 brachytherapy for medium choroidal melanoma. I. Visual acuity after 3 years COMS report no. 16. Ophthalmology 2001;108(2):348–66.
18. Brewington BY, Shao YF, Davidorf FH, Cebulla CM. Brachytherapy for patients with uveal melanoma: historical perspectives and future treatment directions. Clin Ophthalmol 2018;12:925–34.
19. Autorino R, Vicenzi L, Tagliaferri L, Soatti C, Kovacs PG, Aristei C. A national survey of AIRO (Italian Association of Radiation Oncology) brachytherapy (Interventional Radiotherapy) study group. J Contemp Brachytherapy 2018;10(3):254–9.
20. Tagliaferri L, Pagliara MM, Fionda B, Scupola A, Azario L, Sammarco MG, et al. Personalized re-treatment strategy for uveal melanoma local recurrences after interventional radiotherapy (brachytherapy): single institution experience and systematic literature review. J Contemp Brachytherapy 2019;11(1):54–60.
21. Rospond-Kubiak I, Wróblewska-Zierhoffer M, Twardosz- Pawlik H, Kocięcki J. Ruthenium brachytherapy for uveal melanoma - single institution experience. J Contemp Brachytherapy 2017;9(6):548–52.
22. Echegaray JJ, Bechrakis NE, Singh N, Bellerive C, Singh AD. Iodine-125 Brachytherapy for Uveal Melanoma: A Systematic Review of Radiation Dose. Ocul Oncol Pathol 2017;3(3):193–8.
23. Takiar V, Voong KR, Gombos DS, Mourtada F, Rechner LA, Lawyer AA, et al. A choice of radionuclide: Comparative outcomes and toxicity of ruthenium-106 and iodine-125 in the definitive treatment of uveal melanoma. Pract Radiat Oncol 2015;5(3):e169–76.
24. Damiani A, Masciocchi C, Boldrini L, Gatta R, Dinapoli N, Lenkowicz J, et al. Preliminary Data Analysis in Healthcare Multicentric Data Mining: a Privacy-preserving Distributed Approach. Journal of e-Learning and Knowledge Society 2018; 14(1)71–81.
25. Tagliaferri L, Kovács G, Autorino R, Budrukkar A, Guinot JL, Hildebrand G, et al. ENT COBRA (Consortium for Brachytherapy Data Analysis): interdisciplinary standardized data collection system for head and neck patients treated with interventional radiotherapy (brachytherapy). J Contemp Brachytherapy 2016;8(4):336–43.
26. Valentini V, Maurizi F, Tagliaferri L, Balducci M, Cellini F, Gambacorta MA, et al. SPIDER: Managing Clinical Data of Cancer Patients Treated through a Multidisciplinary Approach by a Palm Based System. Italian J Public Health 2008;5(2):66–76.
27. Tagliaferri L, Budrukkar A, Lenkowicz J, Cambeiro M, Bussu F, Guinot JL, et al. ENT COBRA ONTOLOGY: the covariates classification system proposed by the Head & Neck and Skin GEC-ESTRO Working Group for interdisciplinary standardized data collection in head and neck patient cohorts treated with interventional radiotherapy (brachytherapy). J Contemp Brachytherapy 2018;10(3):260–6.