Thus, tumor tissue within the slot is likely to receive less radiation with slotted Selleck 3 MA 106Ru and 90Sr plaques compared with 125I and

103Pd slotted plaques in treatment of juxtapapillary and circumpapillary tumors. The ABS-OOTF recommends (Level 2 Consensus) that all patients with uveal melanoma should be evaluated for metastatic disease before treatment (74). However, staging methods vary throughout the world. They range from relatively nonspecific hematologic surveys, chest X-rays, and ultrasonographic or radiographic imaging of the abdomen (MRI or CT) to total body positron emission tomography/CT [33], [74] and [75]. The ABS-OOTF notes a trend toward greater use of abdominal ultrasound screening in Europe and Russia. However, all regimens focus on the liver as primary or sentinel organ at risk. We agree with the COMS that early detection of metastatic melanoma allows for adjunctive systemic therapy (76). A statistically significant comparison of the efficacy of each form of metastatic survey has not been performed. The ABS-OOTF recommends (Level 2 Consensus) that the presence of metastatic disease from uveal melanoma is not an absolute contraindication for brachytherapy. For example, there exist ocular situations in which brachytherapy may limit LDK378 manufacturer or prevent vision loss from tumor-associated retinal detachment or when tumor growth will soon cause secondary angle closure glaucoma. In addition,

brachytherapy of the primary tumor may allow the patient to enter systemic treatment trial in which a small proportion will survive. The ABS-OOTF does not recommend brachytherapy for patients whose death is imminent or those who cannot tolerate surgery. Brachytherapy is less commonly used as a primary treatment for Rb [23], [77] and [78]. More frequently, radioactive plaques are used secondarily, after local treatment failure (after cryotherapy, chemotherapy [systemic or ophthalmic artery perfusion], focal therapy [e.g., laser or cryotherapy], Liothyronine Sodium EBRT, or a combination thereof (79)). For example, a specific indication for plaque

treatment may be found when there is residual macular Rb that failed control with chemoreduction with subsequent focal therapy. Also in cases when focal therapy would surely affect the patients potential for vision. The ABS-OOTF recommends (Level 2 Consensus) that ideal tumors for primary brachytherapy are located anterior to the equator and in unilaterally affected children. For secondary treatment, residual or recurrent tumors are treated irrespective of location. Exceptions include anterior segment involvement (typically an indication for enucleation) and juxtapapillary location (there exists no reports of slotted plaque therapy for Rb). There exists a worldwide consensus to avoid EBRT when possible. For example, nonplaque brachytherapy implants have been used for orbital recurrence of Rb [80] and [81].