Malignant melanoma of the eyelid and palpebral conjunctiva treated with iodine-125 brachytherapy

Objective: To evaluate the results on malignant melanomas of the eyelid and palpebral conjunctiva treated with iodine-125 (I-125) brachytherapy with s hielding of the eye. Design: Noncomparative case series. Participants: Fourteen patients treated with I-125 brachytherapy at an ocul ar oncology referral center from 1974 through 1996, all of whom had had pre vious debulking, incomplete resection, or recurrence after surgery. Intervention: A stainless steel pericorneal ring eyeshield was attached to the extraocular muscles, over which a lid was fitted to protect the cornea without touching it. iodine-125 seeds in polythene tubes were inserted into the eyelid and attached to the lid margin for a single plane implant. In f ive cases additional seeds were glued on to the shield as well for a volume implant. A median dose of 37 Gy (range, 17.3-67.6 Gy) was given over the c ourse of 113 hours (range, 47-190 hours) to the outer surface of target vol ume. Main Outcome Measures: Local control is regarded as freedom from recurrence in those without measurable disease and complete clinical regression in th ose with measurable disease. Morbidity is assessed in terms of function and cosmesis, Survival is given from the time of the implant. Results: There was local control in 13 patients maintained from ii to 227 m onths (median, 39 months). There were two recurrences at 8 and 13 months in the first patient who received 17.3 Gy. Late complications consisted of mi ld eyelid telangiectasia, mild eyelid atrophy, and loss of eyelashes in mos t patients. five patients, four of whom had upper eyelid tumors, experience d a dry eye, which was managed with tear supplements, and one of these pati ents developed a cataract. A corneal ulcer developed in one eye, which late r perforated after treatment of a subsequent bulbar melanoma and was exente rated, Another eye was enucleated after treatment for a subsequent melanoma in the fornix, Cosmesis was acceptable to patient and doctor in the other 12 patients. Vision was maintained in seven patients, reduced in two, and n ot recorded in the remaining three patients. Three patients died of hematog enous metastases at 44, 62, and 79 months after implant, one of bronchial c arcinoma at 46 months and one of an astrocytoma at 39 months. All patients were clear of local disease. The remainder survived for a median of 45 mont hs (range, 18-227 months). Conclusions: iodine-125 brachytherapy can be used as an alternative to wide excision or exenteration of these tumors. There was good local control, re asonable maintenance of vision, and good cosmesis, (C) 2000 by the American Academy of Ophthalmology.