Long-term follow-up results for choroidal and ciliochoroidal melanomas treated with brachytherapy

Purpose: To determine the demographic features, clinical / tumoral characteristics, and complication and survival rates of patients with choroidal or ciliochoroidal melanoma who had undergone I-125 brachytherapy. Materials and Methods: Medical charts of 165 patients treated with Iodine-125 plaque radiotherapy for choroidal or ciliochoroidal melanoma, between 2003 – 2018 in Ocular Department of Istanbul University Faculty of Medicine, were reviewed retrospectively. All demographic data, initial ocular findings, applied radiation doses, post-treatment complications were collected. Statistical analyses were performed using SPSS, version 21, and the level of significance was set at p <0,05. Kaplan - Meier test was used to estimate survival time and development of complications. Results: The mean age of the patients was 52,9 (range, 11-83). Out of 165 patients, 87 were male (52,7%), 78 were female (47,3%). Tumors were choroidal in 133 eyes (80,6%) and ciliochoroidal in 32 (19,4%). The mean basal diameter was 11,6 (range, 4 - 18) mm, and the mean thickness was 6,2 (range, 2 - 13) mm. According to the AJCC classification, 21,2% of the tumors were T1, 40,6% T2, 36,4% T3, and 1,8% T4 size. A mean dose of 84,11 Gy radiation was applied to the tumor apex. After a mean period of 50,2 (range, 6-163) months of follow-up, the mean initial tumor thickness of 6,19 (standard deviation, ± 2,37) mm was decreased to 3,47 (standard deviation, ± 1,77) mm. Radiation-induced cataract developed in 64 (38,8%) patients, neovascular glaucoma in 17 (10,3%), non-proliferative radiation retinopathy in 98 (59,3%), proliferative radiation retinopathy in 7 (4,2%), radiation maculopathy in 91(55.2%), and radiation papillopathy in 44 (26,7%). After treatment, 74 (44.8%) of the patients had visual acuity of 0.1 or above. The globe was preserved in 157 (95.2%) patients. The remaining 8 patients (4.8%) were treated with secondary enucleation. Metastatic disease occurred in 25 patients (15.2%). At the last follow-up visit, 20 patients (12.1%) had died due to metastatic disease. The probability of survival was 94.5% for the 3rd year and 86.9% for the 5th year. According to Kaplan-Meier analysis, the 5-year survival rate was significantly higher in choroidal melanomas (91%) compared to ciliochoroidal melanomas (63%) (p = 0.08). Conclusion: Over a 15-year follow-up of patients managed with Iodine-125 plaque radiotherapy for choroidal and ciliochoroidal melanomas resulted in a final visual acuity of ≥0,1 in almost half of the cases. Ocular salvage and 5-year survival rates were 95.2% and 86.9%, respectively.