Repeat Episcleral Plaque Brachytherapy: Clinical Outcomes in Patients Treated for Locally Recurrent Posterior Uveal Melanoma

Purpose To report the outcomes of survival, local control, visual acuity, and eye retention in patients treated with repeat episcleral plaque brachytherapy (EPBT) for locally recurrent posterior uveal melanoma (PUM). Design Retrospective, interventional case series. Methods Setting: Institutional. Patient Population: A total of 1201 patients that underwent iodine-125 (I-125) EPBT as primary treatment for PUM between 1985 and 2015. Inclusion Criteria: Development of locally recurrent disease and retreatment with I-125 EPBT. Observation Procedures: Clinical records review. Main Outcome Measures: Visual acuity, Kaplan-Meier estimates of survival, local control, metastasis, and loss of the eye over the duration of follow-up. Results Twenty-seven patients (13 men) met our inclusion criteria. Median (range) follow-up from initial treatment was 100 months (14–365 months), while median time to local recurrence was 43 months (9–185 months). Median (range) follow-up after retreatment was 47 months (3–120 months). Kaplan-Meier estimate for local control at 5 years was 77.2% (95% confidence interval [CI], 53.29%–89.91%). All marginal recurrences were successfully retreated whereas 6 of 15 patients with central recurrence developed subsequent re-recurrence following salvage EPBT. Median (range) visual acuity was 20/70 (20/20 to counting fingers at 1 foot) at time of recurrence and declined to counting fingers (20/25 to hand motion) at the most recent follow-up examination. Kaplan-Meier estimate for absence of metastatic disease at 5 years was 78.5% (95% CI, 54.77%–90.70%). Conclusions Repeat I-125 EPBT offers a viable alternative to enucleation in patients with local recurrence of PUM, yielding high rates of local control with predictable decline in visual acuity.