Management of conjunctival melanoma with local excision and adjuvant brachytherapy

Eye (2020)Cite this article

Subjects

Abstract

Background/objectives

To evaluate the management of conjunctival melanoma with local excision and adjuvant brachytherapy.

Subjects/methods

Data of all patients who received local excision and adjuvant brachytherapy for conjunctival melanoma between 1999 and 2016 in a Dutch national referral centre were reviewed. A protocol with Sr-90 was used until 2012, a protocol with Ru-106 was used hereafter. Local recurrence, metastasis, survival, visual acuity and treatment complications were assessed.

Results

A total of 58 patients was identified: 32 patients were treated with Sr-90 and 26 with Ru-106. Mean follow-up time was 97.3 months (143.1 months after Sr-90, and 40.2 months after Ru-106). All lesions were epibulbar, the median tumour thickness was 0.9 mm. Local recurrence occurred in 13/58 cases (22%), with a 5-year recurrence rate of 21%. Local recurrence occurred equally often in both protocols, with 5-year recurrence rates of 19% (Sr-90) versus 23% (Ru-106) (p = 0.68). Metastasis developed in 3/58 cases (5%), with 2 cases after Sr-90, and 1 after Ru-106 (p = 1.00). The most reported complications were pain (29%), dry eyes (21%), symblepharon (9%), ptosis (12%) and cataract (9%). No severe corneal or scleral complications were observed. Median visual acuity was 1.00 pre-surgery, at the end of follow-up this was 1.00 (Sr-90) and 0.95 (Ru-106).

Conclusion

Local excision with adjuvant brachytherapy provides good tumour control with excellent visual outcome and mild side effects in patients with limited conjunctival melanoma. Results after Sr-90 or Ru-106 were comparable; a choice for either treatment may be based on experience of the clinician and availability of materials.

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Fig. 1: Brachytherapy devices.
Fig. 2: Recurrence-free survival per treatment protocol.

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Acknowledgements

The authors like to thank Leo Blank, MD (Academic Medical Center/University of Amsterdam, The Netherlands) for his contributions to the Strontium-90 treatment of the study population and critical revision of the manuscript.

Funding

NJB is the recipient of a MD/PhD-programme grant of the Leiden University Medical Center. The sponsor or funding organisation had no role in the design or conduct of this research.

Author information

Author notes

  1. These authors contributed equally: Niels J. Brouwer, Marina Marinkovic

Affiliations

  1. Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands

    Niels J. Brouwer, Marina Marinkovic, Rob J. W. de Keizer, Jaco C. Bleeker, Martine J. Jager & Gregorius P. M. Luyten

  2. Netherlands Cancer Institute, Amsterdam, The Netherlands

    Femke P. Peters

  3. Department of Radiation Oncology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands

    Maarten C. C. M. Hulshof & Bradley R. Pieters

  4. Department of Ophthalmology, University of Antwerp, Antwerp, Belgium

    Rob J. W. de Keizer

  5. Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands

    Nanda Horeweg, Mirjam S. Laman & Carien L. Creutzberg

  6. Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands

    Sjoerd G. van Duinen

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  1. Niels J. Brouwer
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Correspondence to Marina Marinkovic.

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Brouwer, N.J., Marinkovic, M., Peters, F.P. et al. Management of conjunctival melanoma with local excision and adjuvant brachytherapy. Eye (2020). https://doi.org/10.1038/s41433-020-0879-z

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