Ruthenium-106 brachytherapy and central uveal melanoma.

Purpose: Uveal melanoma (UM) is the most common primary ocular malignancy. The size and location of the tumor are decisive for brachytherapy with the β-emitting ruthenium-106 (Ru-106) plaque. The treatment of juxtapapillary and juxtafoveolar UM may be challenging because of the proximity or involvement of the macula and optic nerve and high recurrence rates.

Methods: Central UMs were defined as lesions up to 5 mm off the optic disc or fovea radius of 5 mm. Between January 2011 and July 2020, we treated 56 patients with Ru-106-brachytherapy. The clinical outcomes for recurrence, visual acuity, and radiation-related toxicity were assessed. The follow-up was 66 (6-136) months.

Results: Of the 56 patients (56 eyes), 8 (14%) suffered from local recurrence. Six relapsing UM in 19 (32%) patients were located close to the optic disc, and two patients had UM close to the macula (2/37, 5%) (p > 0.05). The overall eye-preservation rate was 89%. The pretreatment visual acuity (VA) was 0.45 and reduced to 0.26 after brachytherapy. Radiation retinopathy or optic neuropathy was detected in 7 (13%) patients and radiation maculopathy in 10 (17.9%). Six patients (11%) underwent enucleation for recurrence or radiation-induced ophthalmopathy.

Conclusion: Central UMs are challenging to treat. UMs should be categorized as lesions laterally or medially to the fovea because of different long-term control rates. Localization near the optic disc requires thoughtful management.