Abstract

SO.07.03

Treatment of conjunctival melanoma Brachytherapy with Ruthenium-106 plaques

Michael Freistühler1, Henrike Westekemper2, Harun Akgül1, Theodora Gkika1, Mete Gök1, Dirk Flühs3, Wolfgang Sauerwein3, Klaus-Peter Steuhl2, Norbert Bornfeld1
1Abt. für Erkrankungen des hinteren Augenabschnittes, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, 2Abt. für Erkrankungen des vorderen Augenabschnittes, Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, 3Strahlenklinik, Universität Duisburg-Essen, Essen

Objective
Clinical outcome in terms of local recurrence and metastasis after ancillary beta ray brachytherapy following surgical excision of conjunctival melanoma.
Methods
Retrospective data assesment of 59 patients with conjunctival melanoma and ancillary beta ray brachytherapy using 106-ruthenium radioactive eye plaques. Patients were divided in two groups according to the localization of the tumor. Group A consists of tumors with a focal localization and group B of multifocal tumors. Subgroups were further defined as patients having ancillary brachytherapy directly after excisional biopy or having brachytherapy either after local recurrence or when the histological work-up showed incomplete excision of the tumor. Clinical outcomes were analysed with respect to recurrence rate, time interval between primary therapy and recurrence and the need of additional tumor treatment. Parameters like infiltration depth, histopathological type of differentiation and the pigmentation of the tumor were reviewed, in order to identify a potential effect on the outcome of ancillary brachytherapy.
Results
Only 4 of 59 eyes (6,8%) had an unfavorable multifocal localization of the tumor. In 16 eyes (27,1%) the indication for primary brachytherapy was an incomplete resection and in 7 eyes (11,9%) a histologically proven recurrence of the tumor occured. In spite of previous brachytherapy 9 eyes (15,3%) manifested had a recurrence of the tumor. In 5 eyes (8,5%) 2 or more recurrences occurred. In this cases the mean time interval since brachytherapy was about 28,3 month. In 3 cases (5,1%) an exenteration could not be avoided.
A correlation between the histopathological type and the time interval to tumor recurrence was not possible. No difference was found between pigmented and amelanotic tumors in terms of tumor recurrence.
Conclusions
The treatment of conjunctival melanomas is complicated because of the frequent diffuse growth of the tumor and the subsequent difficulty to achieve a R0-resection. Even in unifocal tumors a high tumor reccurence rate was found. Ancillary brachytherapy using ruthenium-106 plaques, however, reduced the incidence of recurrences. In a high proportion of patients excisional biopsy in combination with ancillary beta ray brachytherapy may avoid the mutilating effect of orbital exenteration.

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