eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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2/2021
vol. 13
 
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abstract:
Original paper

Intra-operative ocular ultrasonography of iodine-125 brachytherapy plaques in patients with uveal melanoma

Antonio Piñeiro Ces
1
,
Manuel Bande Rodriguez
1
,
Javier Mosquero Sueiro
2
,
Ana María Carballo Castro
3
,
Ramón Lobato Busto
2
,
Paula Silva Rodriguez
1
,
María Pardo Pérez
1
,
Francisco Ruiz Oliva-Ruiz
1
,
Maria Jose Blanco Teijeiro
1

  1. Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Spain, 2Radiophysic Department, Spain
  2. Radiophysic Department, Spain
  3. Radiotherapy Department, Spain
J Contemp Brachytherapy 2021; 13, 2: 126–134
DOI: https://doi.org/10.5114/jcb.2021.105279
Online publish date: 2021/04/14
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Introduction
Brachytherapy with iodine-125 (125I) has been extensively used as a conservative treatment for uveal melanoma (UM). Surgical technique for correct placement of episcleral radioactive plaques (ERP) in UM cases with posterior choroidal location and/or small size can be difficult and inaccurate. In this study, the correct positioning of plaques was assessed by intra-operative ultrasound control.

Material and methods
This was a longitudinal, retrospective study of consecutive 20 patients with UM (small-medium size and/or posterior location) who received 125I brachytherapy. Location of plaques was adjusted by intra-operative ocular ultrasonography control. To perform ocular intra-operative ultrasonography, a 10 MHz probe was used to longitudinal and transverse bases in corresponding dummy plaques.

Results
The study included 8 males and 12 females, with a mean age of 66.3 years (SD = 14.53), 5 right eyes (RE) and 15 left eyes (LE). In ultrasound examination, 4 UMs were of mushroom morphology and the rest nodular. Means of the size of UM by ultrasound were (mm): Lb: 10.60 (SD = 2.24) × Tb: 9.88 (SD = 1.54) × H: 4.02 (SD = 1.44) (3 cases corresponding to small size of collaborative ocular melanoma study (COMS), and 17 cases to medium). The plaques used were between 14 and 20 mm in diameter, with an average distance between the edge of greater base of the tumor and the edge of plate of 2.44 mm (SD = 0.34). It was necessary to surgically reposition the plaque in 4 cases (20%).

Conclusions
Intra-operative ultrasound control improves the accuracy of radioactive plaque placement for the treatment of medium-small UMs in posterior location. Probably, this technique should be applied in all cases of brachytherapy, regardless of the isotope chosen and the location of tumor mass, in order to perfectly adjust therapeutic position.

keywords:

ocular ultrasound, uveal melanoma, brachytherapy, iodine-125, tilting

  
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