ABSTRACT

Uveal melanoma is the most common intraocular tumor in adults. Clinical studies have shown similar patient survival rates after treatment of medium-sized melanomas when comparing plaque brachytherapy with radioactive iodine-125 versus enucleation. This finding further emphasizes the importance of this globe-sparing treatment. Brachytherapy is a special local radiotherapy technique that aims to deliver high-dose radiation directly to the tumor by sparing the periocular structures. Brachytherapy is still the most widely used treatment for uveal melanoma. Iodine-125 and ruthenium-106 are the most common radioisotopes used in brachytherapy. After brachytherapy, sight-threatening complications occur unavoidably in many patients. Brachytherapy is mostly associated with long-term complications. Radiation retinopathy and cataract formation are the most common treatment-related complications. Brachytherapy provides local tumor control (ocular salvage) in about 90% of patients. Adjunctive transpupillary thermotherapy (sandwich therapy) improves the control rate of local tumors to 97%. About 10% of patients treated with brachytherapy subsequently require enucleation because of local tumor recurrence or neovascular glaucoma at 5 years of follow-up. Metastatic disease occurs in 10% of patients with medium-sized melanoma at 5-year follow-up. This rate increases to 55% at 10-year follow-up in patients with large melanomas (thickness >8 mm). Thus, it is very important to inform the patients under the light of these data prior to brachytherapy.