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While reducing the dose to structures outside the target volume, brachytherapy with bi-nuclide-plaques (BBNP) delivers a higher target dose compared to iodine-plaques. We aimed at analyzing the local tumor control and eye retention probability after BBNP.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>All consecutive cases with large uveal melanoma (tumor thickness\u2009\u2265\u20097\u00a0mm) treated with BBNP at our institution between 01\/1999 and 12\/2020 were included (n\u2009=\u2009576, median follow-up: 30.8\u00a0months [interquartile range, IQR: 12.9\u201357.4]). Univariable and multivariable Cox regression analyses were performed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Secondary enucleation (SE) was performed in 13.5% of cases (n\u2009=\u200978) after the median of 20.0\u00a0months (IQR: 9.0\u201334.7) post-BBNP. The overall rate of local tumor recurrence (LR) in the cohort was 8.5% (n\u2009=\u200949) and was diagnosed at the median post-BBNP interval of 20.0\u00a0months (IQR: 15.6\u201335.2). Of the patients\u2019 baseline characteristics, higher age (&gt;\u200967\u00a0years, adjusted hazard ratio [aHR]\u2009=\u20091.80, <jats:italic>p\u2009=<\/jats:italic>\u20090.011), tumor thickness (&gt;\u20098.5\u00a0mm, aHR\u2009=\u20092.20, <jats:italic>p\u2009=<\/jats:italic>\u20090.002), visual acuity (&gt;\u20090.5 logMAR, aHR\u2009=\u20091.83, <jats:italic>p\u2009=<\/jats:italic>\u20090.009), and sclera dose (&gt;\u20091000\u00a0Gy, aHR\u2009=\u20091.65, <jats:italic>p\u2009=<\/jats:italic>\u20090.034) were independently associated with the risk of SE. In turn, higher age (&gt;\u200967\u00a0years, aHR\u2009=\u20091.93, <jats:italic>p\u2009=<\/jats:italic>\u20090.023), tumor thickness (&gt;\u20098.5\u00a0mm, aHR\u2009=\u20092.02, <jats:italic>p\u2009=<\/jats:italic>\u20090.020), and visual acuity (&gt;\u20090.5 logMAR, aHR\u2009=\u20092.27, <jats:italic>p\u2009=<\/jats:italic>\u20090.005) were independently related to LR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>BBNP facilitates eye retention in 86.5% of patients with large uveal melanoma 2.5\u00a0years after treatment. Patients\u2019 baseline, tumor and treatment characteristics were strongly associated with the risk of SE and LR after BBNP.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s13014-025-02707-7","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T17:29:04Z","timestamp":1753982944000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anatomical outcome after brachytherapy with bi-nuclide (Ru-106\/Iodine-125) plaques in large uveal melanomas"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7370-5077","authenticated-orcid":false,"given":"Leyla","family":"Jabbarli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miltiadis","family":"Fiorentzis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maja","family":"Guberina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boerge","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Rating","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Biewald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nika","family":"Guberina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Fl\u00fchs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Norbert","family":"Bornfeld","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Sauerwein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Stuschke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos E.","family":"Bechrakis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"2707_CR1","unstructured":"Finger PT PA, Sauerwein WAG. 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