gms | German Medical Science

Aims: To evaluate the safety and efficacy of Ruthenium-106 (Ru-106) brachytherapy as adjuvant treatment for conjunctival melanoma.

Methods: We reviewed 29 patients with histopathologically confirmed invasive melanoma of the bulbar conjunctiva, who were treated with excision followed by Ru-106 brachytherapy applying a dose of 130 Gy at 2 mm depth. Five of them were recurrent melanomas previously treated with excision alone (n = 3) or combined excision and cryotherapy (n = 2). Ten cases of conjunctival melanomas were associated with primary acquired melanosis with atypia. The time interval between the last excision and the administration of the brachytherapy varied from 0 to 106 days. The median follow-up was 31 months (3–114 months).

Results: Six patients (20 %) developed recurrences during the follow-up. All of them had primary invasive conjunctival melanoma and two of them were associated with primary acquired melanosis with atypia. Four of the recurrences were distant from the treatment site, two were adjacent to the irradiated area. An orbital exenteration was performed in four patients. Five patients developed cataract, one developed a secondary glaucoma, one patient experienced descemetocoele and six patients had dry eye symptoms. No episcleritis was reported. Four patients died during the follow-up, two of them with metastatic disease and two from non cancer-related causes.

Conclusion: Ru-106 brachytherapy is an effective adjuvant therapy in the management of primary as well as circumscribed invasive melanoma of the bulbar conjunctiva with little ocular morbidity. The primary or recurrent state of the disease and the time between excision and brachytherapie had no impact on the final outcome.