INTRAVITREAL DEXAMETHASONE IMPLANT FOR RADIATION MACULOPATHY SECONDARY TO PLAQUE BRACHYTHERAPY IN CHOROIDAL MELANOMA.

PURPOSE: To evaluate the efficacy of intravitreal dexamethasone implant 0.7 mg (Ozurdex) in radiation maculopathy secondary to plaque brachytherapy in choroidal melanoma. METHODS: Twelve eyes diagnosed of radiation maculopathy secondary to plaque brachytherapy and treated with intravitreal dexamethasone implant were included. Visual acuity, foveal thickness using spectral domain optical coherence tomography, and grade of macular edema, using Horgan classification, were evaluated. RESULTS: Mean age was 65.5 ± 28 years (range, 40-82 years). Mean follow-up was 8.2 ± 7.8 months (range, 2-28 months). Mean visual acuity before treatment was, in logarithm of the minimum angle of resolution scale, 1 ± 0.58 (range, 0.4-2) and mean final visual acuity 0.8 ± 0.58 (range, 0.2-2), showing a nonsignificant trend to improvement (P = 0.091; Wilcoxon's test). Foveal thickness before treatment was 416 ± 263 µm (range, 222-725 µm) and final foveal thickness 254 ± 170 µm (range, 145-750), showing a significant decrease (P = 0.016; Wilcoxon's test). Referring to Horgan classification, a significant reduction in grades before and after treatment was demonstrated (P = 0.007; Wilcoxon's test). CONCLUSION: Ozurdex is a useful treatment for radiation maculopathy associated to plaque brachytherapy for uveal melanoma, with a significant decrease in foveal thickness and a significant improvement in Horgan classification. This anatomical improvement was correlated with a moderate improvement in visual acuity.

Safety and efficacy of indigenously developed Ruthenium-106 eye plaque for brachytherapy of a spectrum of ocular tumors: A case series.

ABSTRACT: Various treatment modalities are available for treatment of ocular tumors, which include chemotherapy, laser, and radiotherapy (external beam radiation therapy or brachytherapy). Brachytherapy using plaque applicator is preferred over external beam radiation therapy when the tumor is well localized, as this therapy delivers radiation dose to the tumor with lower doses to normal tissues in the vicinity. However, plaque therapy is expensive and beyond the reach of many poor patients in India. The Bhabha Atomic Research Center (BARC) recently introduced an indigenous Ruthenium-106 plaque to make brachytherapy treatment available and affordable to all needy patients in India. In the present case series, we report our experience using the indigenous Ru-106 plaque for the treatment of a spectrum of ocular tumors.

Ruthenium-106 eye plaque brachytherapy in the conservative treatment of uveal melanoma: a mono-institutional experience.

BACKGROUND: Traditional treatment for uveal melanoma is the enucleation of the eye with outcomes cosmetically unacceptable and loss of useful vision. Plaque brachytherapy, compared to enucleation, had the advantage to preserve the eye with outcomes cosmetically acceptable and preservation of vision. PATIENTS AND METHODS: From July 1990 to December 2009 one hundred forty-two (142) patients (51 males and 91 females) with small to medium uveal melanoma were treated with 106Ru plaque brachytherapy. The patients underwent a complete staging before brachytherapy with indirect ophthalmoscopy and ultrasounds. Mean tumour thickness was 3.26 mm (1.6-6 mm). The dose scheduled was 80-100 Gy to the apex with a maximum dose of 800 Gy to the sclera. RESULTS: One hundred forty-two have been treated, nine patients had lost the follow-up and drop out; 133 patients were assessed. Mean follow-up was 7.7 years (6 months-18 years). The overall survival at 5, 10 and 15 years was 92%, 85% and 78% respectively. Cancer fee survival was 95%, 90% and 83%, respectively at 5, 10 and 15 year. Radiation-induced toxicity was represented in 47 patients with a 5 year actuarial survival rate free from complications of 54%. CONCLUSIONS: 106Ru plaque brachytherapy is a valid approach for treatment of uveal melanoma. This technique is efficacy and safe, with a low toxicity profile.

Pre and post operative radiation protection in Ru-106 brachytherapy ophthalmic plaque surgery and related material shielding properties.

Pre and post-operative exposure levels of medical staff and people from public in intra-operative Ru-106 ophthalmic brachytherapy are reported, together with attenuation properties of selected shielding materials. In particular radiation exposure of workers during plaque transportation and during medical assistance of implanted plaque patient was measured. Taking into account dose rates and considering standard assistance procedure of hospitalized patients, the exposure of medical staff and people of the public were evaluated for a given workload. In order to provide tools to optimize radiation protection, considering social and economic aspects due to possible hospital discharge or hospital stay, the attenuation properties of common shielding materials (lead, concrete, red brick, PMMA and gypsum) were measured, considering both narrow and broad beam setups. The eye was simulated using a water equivalent phantom and plaque was fixed on it. All measurements were performed with calibrated survey meters. Results were compared with numerical simulation of bremsstrahlung X-ray radiation spectra emitted from patient eye. Exposure levels measured at 1 m distance in front of the implanted eye are 0.05 µSv/h/MBq, at 10 cm from patient head, 0.44 µSv/h/MBq (plaque side), 0.4 µSv/h/MBq (front), 0.25 µSv/h/MBq (lateral, opposed to plaque), 0.2 µSv/h/MBq (back). Average exposure levels, under conservative assumptions, for medical staff is 17 µSv/patient and less than 23 µSv/patient for careers and comforters. TVLs in lead and concrete are about 1.6 cm and 11.5 cm respectively.

Cytogenetic Analysis After Temporary Residence in the Area of the Uncontrolled Ruthenium-106 Release in Russia in September 2017.

In September and October 2017, elevated atmospheric ruthenium contamination was measured in several European countries. The most probable origin of this release of radionuclides was reconstructed to be the Southern Ural region. During that time, five workers from a German company stayed up to 2 wk about 120 km from the Chelyabinsk region in Ekaterinburg, Russia. No clinical symptoms were reported during or after the suspected radiation exposure, and no internal contamination was found in whole-body measurements. However, to investigate radiation protection issues and to clarify the workers' situation in order to reassure them, as they planned to continue working in Ekaterinburg, our laboratory was urgently requested by the company's occupational physician to perform biodosimetry using dicentric analysis to determine if the workers have been exposed to radiation by incorporation of radionuclides. The workers' dicentric yields have been compared to reference data of background frequencies in unexposed individuals, but, as it is not reasonable to quantify individual absorbed radiation doses from internalized beta emitters due to various confounding factors, individual dose estimation has not been performed. Dicentric frequencies for two workers differed significantly from the mean laboratory background level, which could have been induced by an exposure to incorporated radionuclides due to beta emissions by Ru or to gamma irradiation by the decay nuclide of Ru. However, the maximum absorbed radiation doses calculated for a resident in the Ru-contaminated area during that time does not correspond to the observed dicentric frequencies. It cannot be excluded that their dicentric frequencies were already elevated before September 2017, potentially induced by an earlier radiation exposure to diagnostic x rays or even by chance.

Retina dose as a predictor for visual acuity loss in 106Ru eye plaque brachytherapy of uveal melanomas.

BACKGROUND AND PURPOSE: To evaluate the retina dose as a risk factor associated with loss of visual acuity (VA) in 106Ru plaque brachytherapy. MATERIAL/METHODS: 45 patients receiving 106Ru plaques brachytherapy (median follow-up 29.5 months) were included in this study. An in-house developed treatment planning system with Monte Carlo based dose calculation was used to perform treatment planning and dose calculation. Risk factors associated with loss of VA were evaluated using the Cox proportional hazards models, Kaplan-Meier estimates and Pearson correlation coefficients. RESULTS: A significant correlation was found between VA loss and mean (r = 0.49, p = 0.001) and near maximum (r = 0.47, p = 0.001) retina dose D2% and tumor basal diameter (r = 0.50, p < 0.001). The Kaplan-Meier and Cox proportional hazards model yielded a significantly higher risk for VA loss (>0.3Snellen) for patients receiving a maximum dose of >500 Gy (p = 0.002). A Cox multivariate analysis including the macula dose (p = 0.237) and basal diameter (p = 0.791) showed that a high maximum retinal dose is the best risk factor (p = 0.013) for VA loss. CONCLUSION: The study showed that retina dose (D2% and Dmean) is a suitable predictor for VA loss.

Comparative outcomes and toxicities for ruthenium-106 versus palladium-103 in the treatment of choroidal melanoma.

For the treatment of choroidal melanoma, palladium-103 (Pd) and ruthenium-106 (Ru) plaque brachytherapy shows reduced toxicity compared with the historical standard iodine-125. No report has directly compared the clinical outcomes between Pd and Ru, and the reasons for the selection of one over the other remain purely theoretical. Patients with choroidal melanoma with apical tumor height up to 5 mm were included. Patients from Emory University were treated with Pd between 1993 and 2012. Patients from Cleveland Clinic were treated with Ru between 2005 and 2010. Medical records were retrospectively reviewed. We compared post-treatment visual acuity (VA), toxicity, and oncologic outcomes. Pd patients (n=124) and Ru patients (n=42) had a median follow-up of 4.2 and 5.0 years, respectively. Radiation retinopathy-free survival was similar for both radioisotopes, but Ru had lower grades of retinopathy (P=0.006). Pd was associated with worse VA preservation (≥20/40) by year 3 (odds ratio: 3.8; 95% confidence interval: 1.01-14.31, P=0.048). Pd was associated with higher distant metastases-free survival (DMFS) in multivariate analysis (hazard ratio: 0.10; 95% confidence interval: 0.02-0.38; P<0.001). Ru had lower grades of radiation retinopathy and improved long-term VA preservation, but also inferior DMFS, compared with Pd. Because of the inherent limitations of a retrospective analysis, the significance of the inferior DMFS for Ru remains unclear, although the suggestion of a slight inferiority in terms of DMFS for Ru is consistent with the other limited literature. On the basis of this study, we believe that both radioisotopes remain appropriate for the treatment of small choroidal melanomas up to 5 mm in apical height.

Strabismus in adults with uveal melanoma following episcleral plaque brachytherapy.

PURPOSE: To ascertain the incidence of persistent strabismus in patients treated with plaque brachytherapy and its subsequent treatment. METHODS: A single center retrospective case note review of adult patients with persistent diplopia or strabismus following plaque brachytherapy for all types of intraocular tumors between 1996 and 2004. RESULTS: A total of 929 consecutive adults underwent plaque brachytherapy during the study period at a single center. Sixteen patients (1.7%) with treated uveal melanoma developed persistent diplopia or strabismus. In 11 patients (69%) the timing of onset was in the first year, in 2 (13%) in the second year, and one each (6% each) in years 5, 7, and 8. Two patients (13%) did not require any intervention. Fourteen patients (88%) required treatment: 7 (50%) were treated with prisms only, 3 (21%) underwent botulinum toxin (BTXA) injections, and 4 (29%) were treated with extraocular muscle surgery (3 required one operation and one required 2 procedures). CONCLUSIONS: The incidence of ocular motility disorders following plaque brachytherapy in our cohort was 1.7% over 8 years and we include this in the consent process for conservative treatment of intraocular tumors. Options for treatment for persistent diplopia or strabismus include prisms, botulinum toxin injection, or surgery.

Pigmented episcleral deposits after brachytherapy of uveal melanoma.

PURPOSE: To describe the characteristics and evolution of pigmented episcleral deposits after brachytherapy for uveal melanoma to determine their origin and association with melanoma-related mortality. DESIGN: Noncomparative case series. PARTICIPANTS: Two hundred eleven patients (108 males, 103 females; median age, 61 years; range, 14-88 years) who were treated with a single ruthenium and iodine plaque therapy (median dose to tumor base, 475 Gy and 392 Gy, respectively) for a choroidal and ciliary body melanoma. Median tumor diameter and height were 12 mm and 5.5 mm, respectively. Eighty-eight patients were treated prospectively during the study. METHODS: The number and location of pigmented episcleral deposits were recorded under the slit lamp during each visit after brachytherapy. The association of the deposits with tumor characteristics and survival was analyzed with logistic regression and Kaplan-Meier analysis, respectively. MAIN OUTCOME MEASURES: Number and location of episcleral deposits, melanoma-related mortality. RESULTS: The pigmented episcleral deposits ranged from black and brownish spots to slightly thickened patches. Most deposits appeared within the first 6 months after brachytherapy. By 1 year, 85% (95% confidence interval, 77-93) of eyes had at least 1 deposit (median, 6). The deposits increased in number until 7 years from irradiation, and decreased with increasing distance from tumor center. An association between the number of deposits at 1 and 2 years and subsequent melanoma-related mortality could not be confirmed (P = 0.80 and P = 0.31, respectively). CONCLUSIONS: Pigmented macrophage-related episcleral deposits are found in most eyes with uveal melanoma after brachytherapy. Their association with plaque size and isotope rather than with tumor size suggests that radiation atrophy of retinal pigment epithelium and choroid in addition to tumor regression contributes to the formation of the deposits. Knowledge of their existence may save patients from unnecessary enucleation.

Ruthenium-106 plaque brachytherapy for symptomatic vasoproliferative tumours of the retina.

AIM: To investigate the safety and efficacy of beta ray brachytherapy in treatment of vasoproliferative tumours of the retina (VTR). METHODS: 35 consecutive patients with symptomatic VTR were treated with a ruthenium-106 ((106)Ru) plaque. Three tumours had been treated previously (two with cryotherapy; one with transpupillary thermotherapy). 32 VTR (91.4%) were located in the lower half of the retina and all of them were found between the mid-periphery and the ora serrata. The mean tumour thickness was 2.8 mm. An exudative retinal detachment was present in 25 eyes (71.4%) and in 15 cases (42.9%) hard exudates were found in the macula. The major symptom was loss of vision (77.1%). RESULTS: Brachytherapy was well tolerated by every patient. The mean applied dose was 416 Gy at the sclera and 108 Gy at the tumour apex. In all but four eyes (88.6%), it was possible to control the VTR activity. The median follow up time was 24 months. Three of the above mentioned four eyes with treatment failure had had secondary glaucoma before therapy. There was no case of radiation induced neuropathy or retinopathy. Cataract surgery was necessary for five patients. The development of epiretinal gliosis was the most common event during follow up (n = 10, 28.6%). The mean visual acuity decreased slightly (0.33 before and 0.29 after brachytherapy). Multivariate analysis showed that the presence of macular pathology before treatment was associated with a 6.1-fold risk of vision of 0.25 or better (p = 0.03). CONCLUSIONS: beta ray brachytherapy with (1106)Ru plaques was able to control the activity of VTR and retain vision. Cases with secondary glaucoma before treatment had a very poor prognosis.

A choice of radionuclide: Comparative outcomes and toxicity of ruthenium-106 and iodine-125 in the definitive treatment of uveal melanoma.

PURPOSE: Both iodine-125 ((125)I) Collaborative Ocular Melanoma Study and ruthenium-106 ((106)Ru) eye plaques can achieve excellent tumor control in patients diagnosed with uveal melanoma. We analyzed our single institutional experience in the management of ocular melanoma treated with either (125)I or (106)Ru plaque brachytherapy. METHODS AND MATERIALS: The records of 107 patients with uveal melanoma treated with either (106)Ru (n = 40) or (125)I (n = 67) plaque brachytherapy between 2000 and 2008 were retrospectively reviewed. Tumor control parameters and toxicity were assessed. RESULTS: Actuarial 5-year rates of local control, progression-free survival, and overall survival with (106)Ru were 97%, 94%, and 92%, respectively. For (125)I, these values were 83%, 65%, and 80%. In the subset of patients with tumor apex height ≤5 mm (36 (125)I and 40 (106)Ru), there was no difference in overall survival; however, progression-free survival was significantly improved with (106)Ru (P = .02). Enucleation-free survival was significantly different between the 2 subsets, with no enucleations in the (106)Ru cohort (P = .02). Patients treated with (106)Ru experienced reduced retinopathy (P = .03) and cataracts (P < .01). CONCLUSIONS: Both (125)I and (106)Ru eye plaque brachytherapy treatment result in encouraging tumor control for patients with uveal melanoma. We demonstrate that (106)Ru offers these benefits with reduced toxicity in patients treated for uveal melanomas ≤5 mm in apical height.

Does escalation of the apical dose change treatment outcome in beta-radiation of posterior choroidal melanomas with 106Ru plaques?

PURPOSE: To show the results of treating posterior uveal melanomas with 106Ru plaque beta-ray radiotherapy and to review and discuss the literature concerning the optimal apical dose prescription (100 vs. 160 Gy). METHODS AND MATERIALS: Forty-eight patients with uveal melanomas (median height 3.85 mm + 1 mm sclera) were treated with ruthenium plaques. The median apical dose was 120 Gy, the median scleral dose 546 Gy. RESULTS: After 5.8 years of follow-up, the overall 5-year survival rate was 90%, the disease specific 5-year survival rate was 92% (3 patients alive with metastasis). Six percent received a second ruthenium application, 10% of the eyes had to be enucleated. Local control was achieved in 90% of the patients with conservative therapy alone. Central or paracentral tumors showed 50% of the pretherapeutic vision after 4 years, and 80% of the vision was preserved in those with peripheral tumors. The main side effects were mostly an uncomplicated retinopathy (30%); macular degeneration or scarring led to poor central vision in 30% of cases. CONCLUSION: Brachytherapy with ruthenium applicators is an effective therapy for small- and medium-size posterior uveal melanomas. Our results are comparable to other series. The treatment outcome does not seem to be capable of improvement by increasing the apical dose. An internationally accepted model for defining the dosage in brachytherapy is needed.

Plaque radiotherapy for the management of uveal metastasis.

BACKGROUND: Radiotherapy is effective for the management of most uveal metastases, and standard external beam radiotherapy is generally administered during a 3-to 4-week period. For those patients in whom external beam radiotherapy or other methods fail or those patients with solitary uveal metastases, plaque radiotherapy may be an alternative method. OBJECTIVE: To determine the effectiveness of plaque radiotherapy for the management of uveal metastasis. METHODS: A retrospective review of 36 patients with uveal metastases who were examined at the Oncology Service at Wills Eye Hospital, Philadelphia, Pa, and treated with plaque radiotherapy. The clinical findings and follow-up data of the primary tumor and the uveal metastasis were analyzed. RESULTS: Of the 36 patients, 27 (75%) received plaque treatment as primary therapy for the uveal metastasis and 9 (25%) received plaque treatment as secondary therapy after failure of the uveal tumor to respond to external beam radiotherapy, chemotherapy, or hormonal therapy. During treatment, 22 patients (61%) had no other systemic metastasis and 14 (39%) had controlled systemic metastasis. No patients had active metastasis elsewhere. The uveal metastasis was solitary and well circumscribed in all but 1 patient; it measured a mean of 11 mm in basal dimension and 4 mm in thickness. The mean time for treatment was 86 hours, and the mean therapeutic dose was 68.80 Gy to the tumor apex and 235.64 Gy to the tumor base. Regression of the uveal metastasis was documented in 34 patients (94%) during a mean follow-up of 11 months. As early as 3 months after treatment, the mean tumor thickness had decreased to 2 mm. Plaque radiotherapy salvaged 5 of the 6 eyes that had failed prior external beam radiotherapy. Radiation retinopathy, radiation papillopathy, or both were found in 3 patients (8%) and occurred at a mean of 8 months after treatment. At the last examination, 18 patients (50%) were alive (11 with and 7 without active systemic metastasis) and 18 (50%) were dead from systemic metastasis. CONCLUSIONS: Plaque radiotherapy is an effective method for treating selected solitary uveal metastasis. It offers a high degree of tumor control, especially for those eyes in which other methods have failed. Plaque treatment is provided during a short period, minimizing the time demand for these patients with a limited life expectancy.

Survival, anatomic, and functional long-term results in choroidal and ciliary body melanoma after ruthenium brachytherapy (15 years' experience with beta-rays).

PURPOSE: To analyze survival, radiation-related complications, local recurrence, enucleation, and visual acuity after ruthenium-106 irradiation of malignant uveal melanoma. DESIGN: Retrospective study. METHODS: A total of 213 patients treated with ruthenium-106 brachytherapy between 1983 and 1995. End point rates were estimated by life tables, and prognostic factors by Cox proportional hazards regression. Main outcome measures were survival rate, radiation-related maculopathy, radiation-related vascular occlusion, local tumor recurrence, enucleation, and visual acuity (<20/100 at 3 years). RESULTS: At 5 and 10 years, survival was 82% (standard error [SE] 2.7%) and 72% (SE 3.4%), local recurrence 21.7% (SE 3.0%) and 24.3% (SE 3.2%), and enucleation 18.0% (SE 2.7%) and 19.2% (SE 2.8%), respectively. Sixty-one patients showed maculopathy (29%), 36 retinal vascular occlusion (17%), in 33 local recurrence (16%), and 38 enucleation (18%). Age and large tumor diameter were independently associated with survival (P <.0001 and P <.0075, respectively). Age below 40 and melanoma located posteriorly were significant risk factors for maculopathy (P <.0085 and P <.0004, respectively) and vascular occlusion (P <.0415 and P <.0114, respectively). Diameter and Bruch membrane rupture were significant predictors (P <.0032 and P <.0390, respectively) of local recurrence. Visual acuity <20/100 was observed in only 26 of 97 (27%) cases of anterior but 34 of 42 (81%) of posterior tumor (P <.001). CONCLUSION: Although percentage tumor recurrence was high, survival was comparable to series using other treatments. Radiation-related complication rates were acceptable, especially for anterior tumors. Ruthenium therapy can, therefore, be recommended for small and medium-sized tumors with anterior location.

Radiation related complications after ruthenium plaque radiotherapy of uveal melanoma.

AIMS/BACKGROUND: To analyse radiation related complications and secondary enucleation after irradiation of malignant uveal melanoma with ruthenium-106 plaques. METHODS: A series of 100 consecutive eyes irradiated in 1981-91 was analysed using the life table method and the Cox proportional hazards model. The median apical and scleral tumour dose was 100 Gy (range 15-200 Gy) and 1000 Gy (range 200-1200 Gy), respectively. The median follow up time was 2.8 and 2.0 years (range 1 month to 10 years) for anterior and posterior segment complications, respectively. RESULTS: The 3 and 5 year probabilities of being without radiation cataract were 73% and 63%, without neovascular glaucoma 91% and 81%, without vitreous haemorrhage 83% and 74%, without radiation maculopathy 85% and 70%, and without radiation optic neuropathy 90% and 88%, respectively. The risk of radiation cataract was highest with large tumour size (T1 + T2 v T3, p = 0.0027; height < or = 5 v > 5 mm, p = 0.029; largest basal diameter (LBD) < or = 15 v > 15 mm, p < 0.0001) and location of anterior tumour margin anterior v posterior to the equator (p = 0.0003); the risk of neovascular glaucoma with large size (T1 + T2 v T3, p = 0.039; LBD < or = 15 mm v 15 mm, p = 0.021); and the risk of maculopathy and optic neuropathy with proximity of the posterior tumour margin to the fovea and the optic disc (< or = 1.5 v > 1.5 mm; p = 0.030 and p = 0.0004, respectively). In Cox's multivariate analysis the strongest risk indicator for radiation cataract (RR 1.5, 95% CI 1.4-1.6) and vitreous haemorrhage (RR 1.6, 95% CI 1.4-1.8) was the height of the tumour; for neovascular glaucoma the TNM class (RR 6.2, 95% CI 2.7-13.8); for radiation maculopathy location of posterior tumour margin within 2 mm from the fovea (RR 3.4, 95% CI 2.0-6.0); and for radiation optic neuropathy location of tumour margin within 1 DD of the optic disc (RR 6.1, 95% CI 3.0-12.4). The 3 and 5 year probabilities of avoiding enucleation were 92% and 85%, respectively. Ten eyes were enucleated--six because of recurrent tumour growth, three because of treatment complications, and one because of mistakenly suspected extraocular growth. CONCLUSION: The results suggest that the frequency of radiation related complications after ruthenium brachytherapy of uveal melanoma is acceptable, in particular as regard irradiation of small and medium sized tumours for which ruthenium therapy generally is recommended.

[Motility disorders in brachytherapy of choroid melanomas with Ru106 applicators]. / Motilitätsstörungen bei der Brachytherapie von Aderhautmelanomen mit Ru106-Applikatoren.

Accurate visualization of the tumor base by diaphanoscopy is essential for optimal placement of a ruthenium plaque. Depending on the localization of the tumor, dissection of one or more of the rectus muscles is necessary during placement of the plaque or during the course of protracted irradiation. Orthoptic investigations were performed to evaluate the cause of motility disorders and to follow up the functional outcome. In 13 patients (out of 30) who underwent ruthenium-106 therapy for uveal melanomas, one or more muscles had to be dissected during placement of the plaque and were reinserted in the same operation or after removal of the applicator. In 4 cases rectus muscles had to be shifted and were replaced after the irradiation. There were 5 patients who developed motility disorders with double vision. All of them were orthophoric within 6 months without surgery.

Radiation doses to critical groups since the early 1950s due to discharges of liquid radioactive waste from Sellafield.

First, some of the early work is reviewed on exposure pathways in connection with proposed and early liquid radioactive waste discharges from Sellafield. The main historical features of these discharges, affected by relevant plant operations, are then briefly described. The important radiological exposure pathways resulting from the discharges and people's consumption and occupancy habits are considered. To place the changing scenario onto a consistent basis using present-day methodology, a reconstruction of exposures has been carried out using environmental monitoring data and models. The three major pathways are examined of Porphyra/laverbread consumption in South Wales, fish and shellfish consumption near Sellafield, and external exposure over local and more distant sediments. The results show that over the period 1952 to about 1970 the laverbread pathway was probably critical, taking a cautious approach. Effective dose rates fluctuated at around 1 mSv y(-1) from about 1956 to 1971. From about 1970 to 1985, the fish and shellfish pathway was likely to have been critical, with effective dose rates peaking at about 2 mSv y(-1) in 1975-1976. External exposure was likely to have been of lesser importance than the other two pathways until about 1985, when with the retention of previously-released radiocesium on sediments it has become dominant. This phenomenon applies particularly further afield where radiocesium concentrations have been slower to decline; in the Ribble estuary, houseboat dwellers have been the critical group from about 1985. Effective doses have been at about 0.3 mSv y(-1) and declining; they are due to the effects of radiocesium discharges in earlier years. Dose rates have remained within contemporary ICRP dose limits.

[Treatment of conjunctival epithelial tumors: brachytherapy with ruthenium-106]. / Traitement des tumeurs épithéliales de la conjonctive: intérêt de la curiethérapie au ruthénium-106.

INTRODUCTION: Treatment of conjunctival epithelial tumors is not standardized because it is difficult to compare large series in this rare disease. Surgical excision is usual, but the recurrence rate has led several authors to propose alternative therapies. PATIENTS AND METHODS: During the past 20 years, brachytherapy using ophthalmic applicators has been developed and the results of different studies have confirmed the usefulness of this therapy. We report a retrospective study of 13 patients presenting with a conjunctival epithelial tumor treated with ruthenium106 applicators and followed up in our department since 1987. RESULTS AND CONCLUSION: There was no recurrence during a mean follow-up of 48 months. Complications depended on the size of the area treated and the dose of radiation.

[Criteria for assessing the efficacy of brachytherapy of uveal melanomas, complications of therapy and there prevention]. / Kriterii otsenki éffektivnosti brakhiterapii uveal'nykh melanom, oslozhneniia, ikh profilaktika.

The authors assess the efficacy of brachytherapy of uveal melanomas in 954 patients. Strontium ophthalmoapplicators were used in 652, rutenium ones in 302 patients. As a rule, Sr applicators were sutured in patients with tumors up to 3.5 mm thick and Ru ones in cases with tumors thicker than 3.5 mm. A special program was used for individual approach and improving the accuracy of planning. A total of 74.5% of patients have been followed up for at least 3 years, with check-ups every 3-6 months. The effect of brachytherapy was considered positive in cases with complete resorption or at least 50% decrease of the tumor and a stable clinical picture for 9-12 months. In 60% of patients the tumor regressed completely, in 16% partially, and in 24% there were signs of activation of melanoma growth one year after treatment. The frequency of radiation complications was as follows: retinopaty, 3.15%; neuroretinopathy, 1.1%; hemophthalmia, 0.9%; neovascular glaucoma, 1.1%; cataract, 0.63%. The incidence of radiation complications increases with increase of the applicator power and rigidity of exposure. Computer planning of brachytherapy with due consideration for the size of the tumor and the eye and localization of the neoplasm for each case will help decrease the incidence of complications.