ABSTRACT
The aim of our study is to document our cases of choroidal melanoma treated with low
dose rate (LDR) brachytherapy and to correlate the dosimetry and radiobiology with
clinical effects and oncologic outcomes. Data from 157 patients treated from 2014
to 2018 with LDR brachytherapy were used for this investigation. Treatments used a
collaborative ocular melanoma study eye plaque and Iodine-125 radioactive seeds. The
seeds activities were chosen to deliver 85 Gy to the tumor apex or to a prescription
point (if the apex < 5 mm). The plaque sizes used were 10, 12, 14, 16, 18, 20, and
22 mm including notched or deep notched. The plaques were modeled in Varian BrachyVision
version 11.6 (Varian Medical Systems) with seed coordinates from the AAPM Task Group
129. The Task Group 43 from AAPM was used for brachytherapy dose planning. Dose data
were extracted for the apex, prescription point, sclera, retina opposite to the implant,
lens, macula, and optic disc. The radiobiological dosimetry were calculated using
appropriate α/β ratios found in the literature and then correlated to clinical side
effects. Average biologically effective dose for associated organs at risk were calculated
in cases where toxicity occurred. These included: radiation cataract (70.66 Gy), disc
atrophy (475.49 Gy), foveal atrophy (263.07 Gy), radiation papillopathy (373.45 Gy),
radiation maculopathy (213.62 Gy), vitreous hemorrhage (1437.68 Gy), vascular occlusion
(1080.93 Gy), nonproliferative retinopathy (1066.89 Gy), proliferative retinopathy
(1590.71 Gy), exudative retinal detachment (1364.32 Gy), and rhegmatogenous retinal
detachment (2265.54 Gy). Average biologically effective dose was higher in patients
who developed radiation induced long term side effects than in the whole patient population
except for radiation maculopathy. In spite of the small patient population and short-term
follow-up, it is of interest to correlate the radiation induced effects and create
a guideline for the improvement of the treatment of patients treated with LDR brachytherapy.
Keywords
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Article info
Publication history
Published online: May 26, 2022
Accepted:
April 21,
2022
Received in revised form:
March 23,
2022
Received:
January 24,
2022
Identification
Copyright
© 2022 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
