Plaque Radiation Therapy for the Treatment of Juxtapapillary Choroidal Melanoma

Rod Foroozan, MD


January 06, 2009


Choroidal melanoma is the most common primary intraocular tumor in adults. One treatment for choroidal melanoma is plaque radiation therapy. The application of a radioactive plaque is technically difficult for posterior tumors, especially those that are adjacent to the optic disk.[1] The use of a customized, notched plaque can be helpful in such patients.


Plaque radiotherapy for juxtapapillary choroidal melanoma overhanging the optic disc in 141 consecutive patients


Sagoo MS, Shields CL, Mashayekhi A, et al
Arch Ophthalmol. 2008;126:1515-1522


The authors of this retrospective interventional study reviewed the records of 141 eyes of patients with juxtapapillary choroidal melanoma to evaluate tumor control using plaque radiation therapy. The median tumor basal diameter was 11 mm and the median thickness was 5.2 mm. A notched plaque was used in 126 eyes. The median radiation dose was 8,500 cGy, and 54 eyes received adjuvant transpupillary thermotherapy . Retinopathy developed in 87 eyes, maculopathy in 44, papillopathy in 57, neovascular glaucoma in 23, and vitreous hemorrhage developed in 48 eyes. Visual acuity was 20/200 or worse in 72 eyes, and enucleation was necessary in 27 eyes.




Partly because of the difficulty in treating juxtapapillary choroidal melanoma, enucleation remains a common treatment for these patients. However, the use of customized, notched plaque radiation therapy achieved local tumor control in 90% of eyes. Due to the high complication rate, visual prognoses for these eyes were not good. The authors suggested that the use of a posterior notched plaque may be especially helpful in patients who have decreased vision in the fellow eye, and in whom enucleation is a much less viable option.



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