S95
Brachytherapy - Head & neck, skin, eye
ESTRO 2026
Heiko Karle 1 , Marcel Sievers 2 , Achim Fiess 2 , Bernhard Stoffelns 2 , Heinz Schmidberger 1 1 Department of Radiooncology, University Hospital, Mainz, Germany. 2 Department of Ophthalmology, University Hospital, Mainz, Germany Purpose/Objective: Uveal melanoma (UM) is a rare disease but is the most common primary intraocular malignancy in adults. UM is often treated with radiotherapy to prevent enucleation. Development of metastases is reported in up to 50% of cases despite successful primary treatment. Historically, UM-related mortality was 31%, whereas recent studies report 83% 5-year overall survival (OS) and 8% local failure. Data on event-free survival (EFS) comparing time to enucleation or local recurrence are missing. Material/Methods: We retrospectively analysed data of 116 patients diagnosed with localised UM and treated between 2013 and 2024 at the University Medical Center Mainz with Ruthenium-106 brachytherapy and a prescribed dose of 100 Gy. Treatment response was categorised according to RECIST. Univariate time-to-event analyses were performed with the Kaplan–Meier log-rank method. Events were defined as first occurrence of either local failure, enucleation, metastasis or death. Potentially influencing variables were analysed using Cox proportional hazards models. Results: In total, 116 patients were examined. Median follow- up was 42.5 months (95%-CI: 34.4–60.5). Mean age was 66 years (SE ± 2.8), and most patients were in good condition (ECOG 0/1/2: 65%/26%/9%). We treated mostly early-staged tumours (T1:47%, T2:42%, T3:11%) with a mean tumour prominence of 4.3mm (SE ±2.04mm). Most tumours had partial response (64.9%) or stable disease (31%), while complete response (1.8%) or progressive disease (2.7%) were rare. After two and five years enucleation rates were 7.3% (95%- CI: 1.9–12.4) and 11.4% (95%-CI: 3.6–18.6), local recurrence rates were 14.9% (95%-CI: 7.6–21.6) and 22.8% (95%-CI: 13.0–31.5), and metastasis rates were 2.2% (95%-CI: 0-5.3) and 11.4% (95%-CI: 2.6–17.5).Two- and five-year OS was 96.5% (95%-CI: 0.93–1.00) and 91.8% (95%-CI: 0.86–0.98), respectively. Median EFS was 86 months (95%-CI: 45.7–n.a.). In univariable analysis, better EFS was significantly associated with smaller tumour stage (p<0.001), smaller prominence (0–5mm, p<0.001), response (at least partial response) (p<0.001), and fewer comorbidities (ACE-27: 0–1, p=0.02). OS was also significantly improved by smaller tumour prominence (0–5mm, p<0.001). Multivariable Cox regression analysis showed a significant impact of the subgroup ECOG 0–1 (HR: 4.23 [95%-CI: 1.6–11.2], p=0.004) and of tumour prominence (HR: 1.78 [95%-CI: 1.49–2.12], p<0.001).
Conclusion: In early UM, Ruthenium-106 brachytherapy yielded good local and distant control in line with other recent reports. In multivariable Cox regression, we observed tumour prominence as the most relevant factor associated with both worse OS and EFS, while ECOG status was also associated with EFS. Keywords: Uveal melanoma, eye preservation Dosimetric comparison of HDR-BT vs CyberKnife EBRT in postoperative tongue and floor of mouth tumors: OARs and toxicity (initial results) Örs Dr.Ferenczi 1 , Tibor Dr. Major 1 , Georgina Dr. Fröchlich 1 , Gábor Dr. Stelczer 1 , Ferenc Dr. Oberna 2 , Zoltán Dr. Takácsi-Nagy 1 1 Radiotherapy, National Institute of Oncology, Budapest, Hungary. 2 Head and neck surgery, National Institute of Oncology, Budapest, Hungary Purpose/Objective: Brachytherapy has long played a key role in adjuvant radiotherapy for tongue and floor of mouth tumors. This study compares HDR brachytherapy and Digital Poster 755 CyberKnife EBRT in postoperative cases, assessing target coverage, OAR dose (mandible, salivary glands), and acute and late toxicity outcomes. Material/Methods: Between May 2024 and November 2025, 17 patients (11 male, 6 female) with pT1-3 pN1 tongue (n=12) and floor of mouth (n=5) tumors received adjuvant radiotherapy using brachytherapy (n=10) or CyberKnife (n=9). Postoperative RT was indicated for T3 tumors, surgical margins ≤ 2 mm, lymphovascular or perineural invasion. BT was delivered as 15 × 3 Gy, CK as 5 × 7 Gy (EQD2-calculated) using 4 gold markers. Patients completed EORTC QLQ-C30, QLQ-H&N35, and M.D. Anderson Dysphagia Scale questionnaires to assess quality of life, including swallowing, at baseline, end of treatment, 2 weeks, and 3 months after therapy.
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