Single institutional retrospective analysis: treatment of choroidal melanomas with cobalt-60 brachytherapy

Abstract

PURPOSE: To evaluate the outcome of patients with choroidal melanoma treated with conservative therapy with brachytherapy (episcleral Co-60 plaque therapy) at the Hospital do Cancer São Paulo, Brazil. METHODS: We evaluated 102 patients consecutively treated from January, 1999 to June, 1999. Median age, maximum tumor base diameter and apex size were 55.5 years, 9.75 mm and 5 mm, respectively. Doses at the base of the tumor, including 1 mm of sclera, ranged from 157 to 487 Gy (median 284.5 Gy) and to the apex from 37 to 220 Gy (median 106 Gy). RESULTS: The crude eye preservation rate with conservative therapy alone was 78.5%. Five-year overall actuarial survival rate was 92.2% and eye conservation rate was 78%. Side effects were mostly an uncomplicated retinopathy in 39/102 patients (38.2%); macular degeneration or scarring led to poor central vision in 31/102 patients (30.3%) of cases. CONCLUSION: Our experience with cobalt-60 plaque brachytherapy achieved a satisfactory rate of local tumor control, despite the oversized base diameters of treated tumors.

OBJETIVOS: Para avaliar o resultado de tratamento pacientes portadores de melanoma de coróide tratados com braquiterapia (placas episclerais de Co-60) no Hospital do Câncer, São Paulo, Brasil. MÉTODOS: Foram avaliados 108 pacientes tratados consecutivamente de janeiro de 1995 a junho de 1999, com idade mediana de 55,5 anos, diâmetro da base do tumor e altura máximos 9,75 mm e 5 mm, respectivamente. As doses na base do tumor, incluindo 1 mm de esclera variaram de 157 a 487 Gy (mediana 284,5 Gy) e para o ápice de 37 até 220 Gy (mediana 106 Gy). RESULTADOS: A taxa de preservação ocular foi 78,5%, com sobrevida atuarial global em cinco anos, e a taxa de conservação ocular atuarial foram 92,2% e 78%, respectivamente. Os principais efeitos colaterais relacionados ao tratamento foram retinopatia em 39/102 (38,2%) pacientes e degeneração macular, levando a déficit visual central em 31/102 (30,3%) pacientes. CONCLUSÃO: Nossa experiência com placas episclerais de Co-60 alcançou taxa satisfatória de controle de tumor local, apesar dos grandes diâmetros das bases dos tumores.