Treatment-Related Complications and Functional Results after Ruthenium-106 Brachytherapy in Small to Medium Size Uveal Melanomas (Part 2)

Abstract

Purpose To analyze the treatment-related complications after ruthenium-106 brachytherapy in patients with uveal melanoma in terms of radiation-induced optic neuropathy, maculopathy and retinopathy, radiation-related vitreous hemorrhage, and retinal detachment, as well as secondary glaucoma and radiogenic cataract. In addition, the course of visual acuity was analyzed.

Patients/Methods and Materials This retrospective study included 608 patients treated with ruthenium-106 brachytherapy between January 2008 and December 2010 at the Department of Ophthalmology, University Hospital Essen. The follow-up time was 11 years. The occurrence of the radiation-induced complications was analyzed using the Kaplan-Meier method. Cox regression was used for univariate and multivariate risk factor analyses. Hazard ratios were calculated for each variable.

Results Regarding the complications, 34% (N = 207) of the patients had no reported side effects or complications during follow-up. Radiation optic neuropathy was observed in 18.8% (N = 114) of the patients, with a median time to onset of 16 months (range: 3 – 78 months). Radiation maculopathy occurred in 8.2% (N = 50) after a median time of 17 months (range: 3 – 67 months). Radiation retinopathy was observed in 20.1% (N = 122), with a median time to onset of 21 months (range: 6 – 67 months). Secondary glaucoma developed in 9.7% of the patients (N = 53) and radiogenic cataract in 46.8% (N = 227). Vitreous hemorrhage (11.8%, N = 72) and scleral necrosis (2.1%, N = 13) occurred relatively rarely.

Conclusion The observed radiogenic complication rate is comparable with that reported in previous studies.

Zusammenfassung

Ziel Analyse der behandlungsbedingten Komplikationen nach Ruthenium-106-Brachytherapie bei Patienten mit Aderhautmelanom im Hinblick auf strahleninduzierte Optikusneuropathie, Makulopathie und Retinopathie, strahlenbedingte Glaskörperblutung und Netzhautablösung sowie sekundäres Glaukom und radiogene Katarakt. Zusätzlich wurde der Verlauf der Sehschärfe analysiert.

Patienten/Methoden und Materialien Diese retrospektive Studie umfasste 608 Patienten, die zwischen Januar 2008 und Dezember 2010 an der Augenklinik des Universitätsklinikums Essen mit primärer Ruthenium-106-Brachytherapie behandelt wurden. Die Follow-up-Zeit betrug 11 Jahre. Das Auftreten der strahlenbedingten Komplikationen wurde mit der Kaplan-Meier-Methode analysiert. Die Cox-Regression wurde für univariate und multivariate Risikofaktoranalysen verwendet. Für jede Variable wurden Hazard Ratios berechnet.

Ergebnisse Bezüglich der Komplikationen zeigten 34% (n = 207) der Patienten während der Nachuntersuchung keine Nebenwirkungen oder Komplikationen. Eine Strahlenoptikusneuropathie wurde bei 18,8% (n = 114) beobachtet, mit einer mittleren Zeit bis zum Auftreten von 16 Monaten (Spannweite: 3 – 78 Monate). Eine Strahlenmakulopathie trat bei 8,2% (n = 50) nach einer mittleren Zeit von 17 Monaten (Spannweite: 3 – 67 Monate) auf. Eine Strahlenretinopathie wurde bei 20,1% (n = 122) beobachtet, mit einer mittleren Zeit bis zum Auftreten von 21 Monaten (Spannweite: 6 – 67 Monate). Ein sekundäres Glaukom entwickelte sich bei 9,7% der Patienten (n = 53) und radiogene Katarakt bei 46,8% (n = 227). Glaskörperblutung (11,8%, n = 72) und Skleranekrose (2,1%, n = 13) traten relativ selten auf.

Fazit Die beobachtete radiogene Komplikationsrate ist mit der in früheren Studien berichteten vergleichbar.

Conclusions

Already known:

• Plaque brachytherapy has been used for the treatment of UM for more than 30 years and is considered an effective method for local tumor control and eye preservation.

• Due to the close vicinity of the posterior UM border to critical structures of the visual pathway, such as the fovea, macula, and optic disc, the best possible eye and visual preservation is crucial.

• We explored the probability of developing radiogenic side effects after ruthenium-106 brachytherapy and visual preservation.

Newly described:

• Ruthenium-106 brachytherapy is a treatment modality that offers patients with a small to medium sized UM good functional results with reasonable treatment-induced side effects.

• We found acceptable post-irradiation morbidity of the eye, mostly depended on the amount of irradiation applied to critical structures of the visual pathway, such as the macula and optic nerve, but also the anterior segment of the eye.

• Further developments of a more conformal irradiation field concentrated on the target volume, possibly also combined with adjunctive medical or even surgical treatments to protect the retina and optic nerve from damage, might prove to be useful.

Keywords

uveal melanoma - 106-ruthenium - brachytherapy - epidemiology - choroid - retina - ocular tumors

Schlüsselwörter

Aderhautmelanom - 106-Ruthenium - Brachytherapie - Epidemiologie - Chorioidea - Retina - okuläre Tumoren

Publication History

Received: 15 November 2023

Accepted: 22 February 2024

Accepted Manuscript online:
23 February 2024

Article published online:
04 April 2024

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