Staged Eye-Plaque Brachytherapy: A Novel Approach for Large Uveal Melanoma

The purpose of this study is to report our experience regarding the development of a staged eye-plaque brachytherapy approach for large uveal melanoma lesions which would otherwise require enucleation due to toxicity from a single-session approach. In an attempt to avoid enucleation from radiation toxicity, we developed a staged eye-plaque brachytherapy technique in which patients underwent 2 separate I-125 eye-plaque insertions approximately 3 months apart with a cumulative prescription dose of 90 Gy. Using this technique, we treated 2 patients who had large uveal melanomas with basal diameter plus margin at the upper limit of the largest commercially available eye-plaque. The patients are 1- and 2-years posttreatment and both have continued tumor shrinkage with good visual acuity and very minimal appreciable radiation toxicity. Staged eye-plaque brachytherapy for large-diameter uveal melanoma is a novel idea used for 2 patients who would have otherwise undergone enucleation. Preliminary results suggest no local recurrence and no appreciable toxicity. Additional exploration is necessary to determine whether any subset of patients may benefit from this globe-sparing approach as standard of care.