Ruthenium-106 plaque radiotherapy alone or in combination with transpupillary thermotherapy in the management of choroidal melanoma.

Purpose: To evaluate the results of ruthenium-106 (Ru-106) plaque radiotherapy alone (group A) or in combination with transpupillary thermotherapy (TTT) (group B) in the management of choroidal melanoma with tumor thickness (height) <8 mm. The tumors in each group were subclassified as those with thickness 5 and <8 mm.

Methods: In this retrospective review, the main outcome measures were globe conservation rate, the rate of a reduction of at least 50% in tumor thickness, treatment complications, visual acuity (VA) change, and metastasis. Kaplan-Meier curves for prediction of decrease in tumor thickness of at least 50% over time were constructed.

Results: A total of 54 patients (24 in group A and 30 in group B) were included in this study. The groups were matched with respect to patient age, tumor base diameter, tumor thickness, tumor distance to optic disc, tumor distance to foveola, and baseline visual acuity (VA). The mean follow-up was 24.6 months in group A and 44.9 months in group B. Globe conservation was achieved in 21 (87.5%) eyes in group A and in 26 (86.7%) eyes in group B. The globe conservation rates did not differ significantly between groups A and B or between tumors 5 to <8 mm in thickness in each group (P > 0.05). There was no statistical difference between groups A and B in the rate of tumor thickness reduction of at least 50% (P> 0.05). There was a significant decrease in final VA compared to baseline VA in group B (P = 0.007) but not in group A. Radiation complications were similar in groups A and B. Liver metastasis occurred in two patients in group A and in one patient in group B. Statistical analysis could not be carried out for the latter two variables because of the small number of affected patients.

Conclusions: Compared to Ru-106 plaque radiotherapy alone, Ru-106 plaque radiotherapy combined with TTT did not result in a significant change in the globe conservation rate or the rate of at least 50% reduction in tumor thickness in choroidal melanomas <8 mm in thickness. Although Ru-106 plaque radiotherapy is mainly used for choroidal melanomas >or=5 mm thick, it can also be considered in selected tumors with thickness between 5 and 8 mm with comparable tumor control.