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Ruthenium-106 is a radioactive isotope of ruthenium used as a beta-emitting radiopharmaceutical primarily for ophthalmic brachytherapy, most notably for the treatment of small to medium-sized intraocular tumors such as uveal melanoma, retinoblastoma, and iris melanoma. Ruthenium-106 emits high-energy beta particles with a half-life of approximately 374 days, and its limited penetration depth allows for targeted tumor irradiation while minimizing exposure to surrounding healthy tissue. The isotope is usually incorporated into prefabricated, solid-silver-coated plaques that are sutured to the exterior of the eye adjacent to the tumor, remaining in place for several days to deliver a prescribed radiation dose. Mechanistically, the emitted beta radiation causes DNA damage (predominantly double-strand breaks), leading to tumor cell death. Ruthenium-106 and its primary manufacturer, Eckert & Ziegler, have been in clinical use for over fifty years, with broad adoption in Europe for ocular tumors. The most common complications include local ocular toxicities such as cataract, dry eye, and secondary glaucoma, but vision preservation is usually excellent in eligible patients[1][2][3][5][6][7][8].
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