TREATMENT OF CHOROIDAL MELANOMA WITH I-125 PLAQUE

Purposes: To evaluate efficacy of I-125 episcleral plaque therapy in p atients with ocular melanoma and determine survival, eventual visual a cuity, and complications. Methods and Materials: Between July 1, 1984 and January 1, 1991, 144 patients with diagnosis of ocular melanoma we re treated with high activity 1-125 episcleral plaques. Tumor volumes ranged from 14 to 3449 mm3. Lesion size included small (n = 15; height < 5 mm, and/or largest basal diameter of 8-16 mm) and large (n = 45; height > 8 mm, and/or largest basal diameter > 16 mm). Apical doses ra nged from 74.25 to 83.66 Gy with scleral doses ranging from 41 and 160 Gy. Follow-up has ranged from 25 to 90 months (Med = 46 months). Resu lts: Ocular survival was noted in 130/144. Reasons for enucleation inc luded progressive tumor growth (n = 4), extrascleral extension (n = 4) , or blind/painful eye (n = 6), 94 patients developed complications wh ich included cataract (n = 43), optic neuropathy (n = 12), neovascular glaucoma (n = 8) and retinopathies (n = 31). Visual acuity testing pr e-episcleral plaque therapy revealed 102 patients with 20/200 vision; at last follow-up 59 patients demonstrated visual acuity testing of 20 /200 or better. Conclusion: The use of episcleral I-125 plaque therapy allows for safe and effective therapy in patients with ocular melanom a of various size depending on location and probable visual acuity out come. A total apical dose of 75 Gy given at 60-65 cGy/hour provides du rable local control with acceptable complication rates.