HELIUM-IONS VERSUS IODINE 125 BRACHYTHERAPY IN THE MANAGEMENT OF UVEAL MELANOMA - A PROSPECTIVE, RANDOMIZED, DYNAMICALLY BALANCED TRIAL

Purpose: Optimal radiation therapy for uveal melanoma is uncertain, an d the relative efficacies of radioactive plaques and charged particles are unclear. Methods: The authors prospectively studied helium-ion ir radiation and iodine 125 (I-125) brachytherapy in a randomized, dynami cally balanced trial. Of the 184 patients who met the eligibility crit eria, 86 were treated with helium ions and 98 with I-125 brachytherapy . Results: No patients with uveal melanoma had a history of systemic m alignancy. Tumors were less than 15 mm in maximum diameter and less th an 10 mm in thickness. A minimum tumor dose of 70 GyE was delivered to the tumor apex. There was a significantly higher local recurrence rat e after I-125 brachytherapy than after helium-ion irradiation. Enuclea tions occurred more frequently after brachytherapy (relative risk = 1. 99; 95% confidence interval, 0.78-5.78). More anterior segment complic ations occurred after helium-ion irradiation. To date, there has been no measurable impact on survival. Conclusions: Most uveal melanomas ca n be managed with radiation with retention of the eye. There was bette r tumor control with helium-ion irradiation; however, there were more anterior segment complications.