Choroidal Melanoma With Ultrasound-Guided Episcleral Brachytherapy: Long-Term Results and Risk of Metastasis.

PURPOSE/OBJECTIVE(S) To elucidate the long-term outcomes in patients with choroidal melanoma who received episcleral brachytherapy with 125-I seeds; analyze cause-specific survival, metastasis-free survival and local control and establish the relationship between tumor size and metastases. MATERIALS/METHODS From May 2007 to February 2013, 88 patients classified according to American Joint Committee on Cancer guidelines underwent ultrasound-guided episcleral brachytherapy with a total prescribed dose of 72.40 Gy to the apex. RESULTS Among the included cases, 47.7% and 44.3% had a clinical tumor stage of T2 and T3, respectively. With a median follow-up of 84 (range 7-153) months, local control at 5 and 10 years was 100% and 95%, respectively. Among the 88 patients, 9 (10.2%) were enucleated after brachytherapy. Those with T1-T2 and T3-T4 disease had a 10-year cause-specific survival of 100% and 87.3%, respectively (P = 0.017). Metastasis-free survival at 5 and 10 years was 100% in those with T1-T2 disease and 92.1% and 83.1% in those with T3-T4, respectively (P = 0.016). Five patients had liver metastases, all of whom had T3-T4 disease. CONCLUSION Ultrasound-guided episcleral brachytherapy with 125-I seeds yielded excellent local control for choroidal melanoma, with low complication rates and 90% eye preservation. Given the association between tumor stage and liver metastases, which remain the main cause of death, stricter control should be employed for T3-T4 tumors for the early detection and treatment of relapses. AUTHOR DISCLOSURE B. Quiles Hevia: None. J. Mataix: None. J. Guinot: None. V. De los Dolores: None. M. Pena: None. A. La Rosa: None. M. Tortajada: None. M. Santos: None. P. Santamaria: None. S. Canos: None. M. Chust: None. J. Mengual: None. Y. Murria: None. M. Perez: None. C. Pesudo: None. L. Arribas Alpuente: None.