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

Fotios Lalos; Dirk Flühs; Maja Guberina; Norbert Bornfeld; Martin Stuschke; Wolfgang Sauerwein; Nikolaos E. Bechrakis

doi:10.1055/a-2275-5575

Klinische Monatsblätter für Augenheilkunde, Table of Contents

Klin Monbl Augenheilkd 2025; 242(02): 116-126
DOI: 10.1055/a-2275-5575

Klinische Studie

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

Behandlungsbedingte Komplikationen und funktionelle Ergebnisse nach Ruthenium-106-Brachytherapie bei kleinen bis mittelgroßen Aderhautmelanomen (Teil 2)

Fotios Lalos

¹Department of Ophthalmology, University Hospital of Essen, Germany

,

Dirk Flühs

²Department of Radiotherapy, University Hospital of Essen, Germany

,

Maja Guberina

²Department of Radiotherapy, University Hospital of Essen, Germany

,

Norbert Bornfeld

¹Department of Ophthalmology, University Hospital of Essen, Germany

,

Martin Stuschke

²Department of Radiotherapy, University Hospital of Essen, Germany

³German Cancer Consortium (DKTK), Heidelberg, Partner Site University Hospital Essen, Germany

,

Wolfgang Sauerwein

²Department of Radiotherapy, University Hospital of Essen, Germany

,

Nikolaos E. Bechrakis

¹Department of Ophthalmology, University Hospital of Essen, Germany

› Author Affiliations

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.

Keywords

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

Schlüsselwörter

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

Full Text

References

References
1 Kaliki S, Shields CL. Uveal melanoma: relatively rare but deadly cancer. Eye (Lond) 2017; 31: 241-257
2 Singh AD, Turell ME, Topham AK. Uveal melanoma: trends in incidence, treatment, and survival. Ophthalmology 2011; 118: 1881-1885
3 Virgili G, Gatta G, Ciccolallo L. et al. Incidence of uveal melanoma in Europe. Ophthalmology 2007; 114: 2309-2315
4 Lommatzsch PK. Results after beta-irradiation (106Ru/106Rh) of choroidal melanomas: 20 yearsʼ experience. Br J Ophthalmol 1986; 70: 844-851
5 Stallard HB. Radiotherapy for malignant melanoma of the choroid. Br J Ophthalmol 1966; 50: 147-155
6 American Brachytherapy Society – Ophthalmic Oncology Task Force. Electronic address: paulfinger@eyecancer.com, ABS – OOTF Committee. The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma. Brachytherapy 2014; 13: 1-14
7 Flühs D, Bambynek M, Heintz M. et al. Dosimetry and design of radioactive eye plaques. Front Radiat Ther Oncol 1997; 30: 26-38
8 Stannard C, Sauerwein W, Maree G. et al. Radiotherapy for ocular tumours. Eye (Lond) 2013; 27: 119-127
9 Stöckel E, Eichmann M, Flühs D. et al. Dose distributions and treatment margins in ocular brachytherapy with 106Ru eye plaques. Ocul Oncol Pathol 2018; 4: 122-128
10 Zaragoza FJ, Eichmann M, Flühs D. et al. Monte Carlo estimation of absorbed dose distributions obtained from heterogeneous 106Ru eye plaques. Ocul Oncol Pathol 2017; 3: 204-209
11 Lommatzsch PK, Alberti W, Lommatzsch R. et al. Radiation effects on the optic nerve observed after brachytherapy of choroidal melanomas with 106Ru/106Rh plaques. Graefes Arch Clin Exp Ophthalmol 1994; 232: 482-487
12 Puusaari I, Heikkonen J, Kivelä T. Ocular complications after iodine brachytherapy for large uveal melanomas. Ophthalmology 2004; 111: 1768-1777
13 Shields CL, Shields JA, Karlsson U. et al. Reasons for enucleation after plaque radiotherapy for posterior uveal melanoma. Clinical findings. Ophthalmology 1989; 96: 919-923
14 Summanen P, Immonen I, Kivelä T. et al. Radiation related complications after ruthenium plaque radiotherapy of uveal melanoma. Br J Ophthalmol 1996; 80: 732-739
15 Collaborative Ocular Melanoma Study Group. Incidence of cataract and outcomes after cataract surgery in the first 5 years after iodine 125 brachytherapy in the Collaborative Ocular Melanoma Study: COMS Report No. 27. Ophthalmology 2007; 114: 1363-1371
16 Kim MK, Char DH, Castro JL. et al. Neovascular glaucoma after helium ion irradiation for uveal melanoma. Ophthalmology 1986; 93: 189-193
17 Wen JC, Oliver SC, McCannel TA. Ocular complications following I-125 brachytherapy for choroidal melanoma. Eye (Lond) 2009; 23: 1254-1268
18 Beykin G, Peʼer J, Hemo Y. et al. Pars plana vitrectomy to repair retinal detachment following brachytherapy for uveal melanoma. Br J Ophthalmol 2013; 97: 1534-1537
19 Bianciotto C, Shields CL, Pirondini C. et al. Vitreous hemorrhage after plaque radiotherapy for uveal melanoma. Retina 2012; 32: 1156-1164
20 Chia SN, Smith HB, Hammer HM. et al. Incidence and indications for pars plana vitrectomy following the treatment of posterior uveal melanomas in Scotland. Eye (Lond) 2015; 29: 748-756
21 Kivelä T, Eskelin S, Mäkitie T. et al. Exudative retinal detachment from malignant uveal melanoma: predictors and prognostic significance. Invest Ophthalmol Vis Sci 2001; 42: 2085-2093
22 Jabbarli L, Guberina M, Biewald E. et al. Scleral necrosis after brachytherapy for uveal melanoma: Analysis of risk factors. Clin Exp Ophthalmol 2021; 49: 357-367
23 Kaliki S, Shields CL, Rojanaporn D. et al. Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study. Ophthalmology 2013; 120: 1004-1011
24 Damato B, Patel I, Campbell IR. et al. Visual acuity after Ruthenium(106) brachytherapy of choroidal melanomas. Int J Radiat Oncol Biol Phys 2005; 63: 392-400
25 Kaiserman N, Kaiserman I, Hendler K. et al. Ruthenium-106 plaque brachytherapy for thick posterior uveal melanomas. Br J Ophthalmol 2009; 93: 1167-1171