PLAQUE RADIOTHERAPY FOR THE MANAGEMENT OF UVEAL METASTASIS

Background: Radiotherapy is effective for the management of most uveal metastases, and standard external beam radiotherapy is generally admi nistered during a 3- to 4-week period. For those patients in whom exte rnal beam radiotherapy or other methods fail or those patients with so litary uveal metastases, plaque radiotherapy may be an alternative met hod. Objective: To determine the effectiveness of plaque radiotherapy for the management of uveal metastasis. Methods: A retrospective revie w of 36 patients with uveal metastases who were examined at the Oncolo gy Service at Wills Eye Hospital, Philadelphia, Pa, and treated with p laque radiotherapy. The clinical findings and follow-up data of the pr imary tumor and the uveal metastasis were analyzed. Results: Of the 36 patients, 27 (75%) received plaque treatment as primary therapy for t he uveal metastasis and 9 (25%) received plaque treatment as secondary therapy after failure of the uveal tumor to respond to external beam radiotherapy, chemotherapy, or hormonal therapy. During treatment, 22 patients (61%) had no other systemic metastasis and 14 (39%) had contr olled systemic metastasis. No patients had active metastasis elsewhere . The uveal metastasis was solitary and well circumscribed in all but 1 patient, it measured a mean of 11 mm in basal dimension and 4 mm in thickness. The mean; time for treatment was 86 hours, and the mean the rapeutic dose was 68.80 Gy to the tumor apex and 235.64 Gy to the tumo r base. Regression of the uveal metastasis was documented in 34 patien ts (94%) during a mean follow-up of II months. As early as 3 months af ter treatment, the mean tumor thickness had decreased to 2 mm. Plaque radiotherapy salvaged 5 of the 6 eyes that had failed prior external b eam radiotherapy. Radiation retinopathy, radiation papillopathy, or bo th were found in 3 patients (8%) and occurred at a mean of 8 months af ter treatment. At the last examination, 18 patients (50%) were alive ( 11 with and 7 without active systemic metastasis) and 18 (50%) were de ad from systemic metastasis. Conclusions: Plaque radiotherapy is an ef fective method for treating selected solitary uveal metastasis. It off ers a high degree of tumor control, especially for those eyes in which other methods have failed. Plaque treatment is provided during a shor t period, minimizing the time demand for these patients with a limited life expectancy.