Juxtapapillary and circumpapillary choroidal
melanoma: globe-sparing treatment outcomes with iodine-125
notched plaque brachytherapy
John V. Hegde
Tara A. McCannel
Colin A. McCannel
D. Jeffrey Demanes
Received: 6 December 2016 /Revised: 24 April 2017 /Accepted: 30 May 2017 / Published online: 9 June 2017
Springer-Verlag Berlin Heidelberg 2017
Purpose Managing juxtapapillary and circumpapillary choroi-
dal melanoma with brachytherapy is challenging because of
technical complications with accurate plaque placement and
high radiation toxicity given tumor proximity to the optic nerve.
We evaluated our center’s experience using ultrasound-guided,
Iodine (I)-125 notched plaque brachytherapy for treating cho-
roidal melanoma contiguous with (juxtapapillary) and at least
partially surrounding the optic disc (circumpapillary).
Methods All cases of choroidal melanoma treated with I-125
notched plaque brachytherapy at our center from September
2003–December 2013 were retrospectively reviewed. Only
patients with ≥18 months of follow-up who had lesions con-
tiguous with the optic disc (0 mm of separation) were includ-
ed. The tumor apex prescription dose was 85 Gy. Outcomes
evaluated included local control, distant metastasis-free sur-
vival (DMFS), cancer-specific survival (CSS), overall surviv-
al (OS), visual acuity, and radiation toxicity.
Results Thirty-four patients were included with a median
follow-up of 44.1 months (range 18.2–129.0). AJCC T-
category was T1 in 58.8%, T2 in 26.5%, and T3 in 14.7%.
Median circumferential optic disc involvement was 50%
(range 10%–100%). Eye retention was achieved in 94.1%.
Actuarial 2- and 4-year rates of local recurrence were 3.1%
and 7.6%, DMFS were 97.0% and 88.5%, CSS were 97.0%
and 92.8%, and OS were 97.0% and 88.9%, respectively. In
addition, 23.5% had visual acuity ≥20/200 at last follow-up.
Conclusions I-125 notched plaque brachytherapy provides
high eye preservation rates with acceptable longer-term post-
treatment visual outcomes. Based on our experience, choroi-
dal melanoma directly contiguous with and partially encasing
the optic disc may be effectively treated with this technique.
Keywords Choroidal melanoma
The long-term results of the Collaborative Ocular Melanoma
Study (COMS) for medium-sized choroidal melanomas
established Iodine (I)-125 brachytherapy as a primary treat-
ment option by demonstrating no difference in overall survival
between I-125 brachytherapy and enucleation for lesions
>2 mm from the optic disc .
For lesions either <2 mm from the optic disc (juxtapapillary)
or those wrapping around the optic disc (circumpapillary), there
are multiple options for management, including various plaque
brachytherapy techniques [2, 3]. Improvements in plaque de-
sign, using either a notched or slotted technique, in addition to
the utilization of ultrasound guidance for confirmation of ap-
propriate plaque placement, can be employed to overcome the
perceived limitations of brachytherapy for these more
challenging-to-treat lesions. Adjuvant transpupillary
Electronic supplementary material The online version of this article
(doi:10.1007/s00417-017-3703-0) contains supplementary material,
which is available to authorized users.
* John V. Hegde
Department of Radiation Oncology, 200 UCLA Medical Plaza, Suite
B265, University of California, Los Angeles, Los
Angeles, CA 90095, USA
Department of Ophthalmology, Stein Eye Institute, 100 Stein Plaza
UCLA, University of California, Los Angeles, Los
Angeles, CA 90095, USA
Graefes Arch Clin Exp Ophthalmol (2017) 255:1843–1850