Plaque radiotherapy for the management of uveal metastasis
C. L. Shields, J. A. Shields, P. De Potter, M. Quaranta, J. Freire, L. W. Brady and J. Barrett
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pa., USA.
BACKGROUND: Radiotherapy is effective for the management of most uveal
metastases, and standard external beam radiotherapy is generally
administered during a 3-to 4-week period. For those patients in whom
external beam radiotherapy or other methods fail or those patients with
solitary uveal metastases, plaque radiotherapy may be an alternative
method. OBJECTIVE: To determine the effectiveness of plaque radiotherapy
for the management of uveal metastasis. METHODS: A retrospective review of
36 patients with uveal metastases who were examined at the Oncology Service
at Wills Eye Hospital, Philadelphia, Pa, and treated with plaque
radiotherapy. The clinical findings and follow-up data of the primary tumor
and the uveal metastasis were analyzed. RESULTS: Of the 36 patients, 27
(75%) received plaque treatment as primary therapy for the uveal metastasis
and 9 (25%) received plaque treatment as secondary therapy after failure of
the uveal tumor to respond to external beam radiotherapy, chemotherapy, or
hormonal therapy. During treatment, 22 patients (61%) had no other systemic
metastasis and 14 (39%) had controlled systemic metastasis. No patients had
active metastasis elsewhere. The uveal metastasis was solitary and well
circumscribed in all but 1 patient; it measured a mean of 11 mm in basal
dimension and 4 mm in thickness. The mean time for treatment was 86 hours,
and the mean therapeutic dose was 68.80 Gy to the tumor apex and 235.64 Gy
to the tumor base. Regression of the uveal metastasis was documented in 34
patients (94%) during a mean follow-up of 11 months. As early as 3 months
after treatment, the mean tumor thickness had decreased to 2 mm. Plaque
radiotherapy salvaged 5 of the 6 eyes that had failed prior external beam
radiotherapy. Radiation retinopathy, radiation papillopathy, or both were
found in 3 patients (8%) and occurred at a mean of 8 months after
treatment. At the last examination, 18 patients (50%) were alive (11 with
and 7 without active systemic metastasis) and 18 (50%) were dead from
systemic metastasis. CONCLUSIONS: Plaque radiotherapy is an effective
method for treating selected solitary uveal metastasis. It offers a high
degree of tumor control, especially for those eyes in which other methods
have failed. Plaque treatment is provided during a short period, minimizing
the time demand for these patients with a limited life expectancy.
