Changes in height of choroidal melanomas after plaque therapy.

Abramson, David H.; Servodidio, Camille A.; McCormick, Beryl; Fass, Daniel; Zang, Edith

doi:10.1136/bjo.74.6.359

Cited by 26 publications

(31 citation statements)

References 7 publications

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“…Flattening of the tumour depended on the initial tumour thickness, as was also observed after plaque radiotherapy as sole treatment. 11 The mean time to development of a flat scar was statistically significant faster in tumours (3 mm compared to tumours .3 mm (Fig 1). The cut off at 3 mm was chosen because the mean tumour thickness reduction 3 months after combined TTT and plaque radiotherapy was 3.0 mm, as reported by Oosterhuis et al 6 That thicker melanomas continued to flatten during the 5 year follow up may be due to the late effect of plaque radiotherapy, whereby cell damage progresses slowly and continues for several years, whereas TTT induced tumour necrosis and vascular occlusion results in tumour regression within several months.…”

Section: Discussionmentioning

confidence: 88%

Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience

Bartlema

Oosterhuis²,

Korver³

et al. 2003

British Journal of Ophthalmology

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Aim: To evaluate the results of combined plaque radiotherapy and transpupillary thermotherapy (TTT) in 50 consecutive patients 5 years after treatment. Methods: 50 adult patients with choroidal melanoma were treated with ruthenium-106 ( 106 Ru) plaque radiotherapy combined with TTT. A flat scar was the preferred end point of treatment. The mean tumour thickness was 3.9 mm (range 1.5-8.0 mm), the mean tumour diameter was 11.3 mm (range 5.8-15.0 mm). TTT was performed with an infrared diode laser at 810 nm, a beam diameter of 2-3 mm, and 1 minute exposures. Tumours .5 mm thick received an episcleral contact dose of 800 Gy 106 Ru; tumours (5 mm thick received a contact dose of 600 Gy 106 Ru. TTT was repeated in case of incomplete tumour regression after combined therapy. Results: Complete tumour regression was obtained in 45 patients. It required one, two, or three TTT sessions in 32, 11, and two patients, respectively. In tumours (3 mm thick complete flattening was achieved significantly faster than in tumours .3 mm thick (log rank test p = 0.01). Eight melanomas were amelanotic, seven of which required multiple TTT sessions. In one patient the tumour recurred at the central margin of the treated area; this eye was enucleated. In one patient the tumour failed to regress 6 months after treatment and enucleation was performed at the patient's request. Three eyes developed severe proliferative retinopathy. Radiation maculopathy caused a loss of the best corrected visual acuity: before treatment 31 patients had a best corrected visual acuity of 20/60 or better but in only 12 patients did it remain in this range 5 years after treatment. Three patients developed distant metastasis to the liver. Conclusion: The 5 year results for combined plaque radiotherapy and TTT as treatment for choroidal melanoma are favourable in terms of complete tumour regression and low rate of recurrences; however, there was considerable loss of visual acuity as a result of radiation maculopathy.

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Section: Discussionmentioning

confidence: 88%

Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience

Bartlema

Oosterhuis²,

Korver³

et al. 2003

British Journal of Ophthalmology

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“…Recurrence or unresponsiveness following plaque brachytherapy may indicate failure of local tumor control. Abramson et al25 showed a 12% tumor reduction (88% residual tumor burden) at 6 months following plaque brachytherapy, which increased to a 24% reduction (76% residual tumor burden) at 12 months. Following combined treatment with I-125 plaque brachytherapy and intravitreal bevacizumab, there was a significant decrease in tumor burden at all time points compared with baseline ( P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Tumor burden with brachytherapy alone (Abramson et al25) compared with combined treatment with plaque brachytherapy and intravitreal bevacizumab.…”

Section: Figurementioning

confidence: 99%

Intravitreal bevacizumab combined with plaque brachytherapy reduces melanoma tumor volume and enhances resolution of exudative detachment

Houston¹,

Shah²,

Decatur³

et al. 2013

OPTH

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BackgroundThe purpose of this study was to evaluate intravitreal bevacizumab as an adjuvant treatment to plaque brachytherapy in the treatment of choroidal melanoma.MethodsThis was a retrospective, consecutive study of 124 patients treated from 2007 to 2009 for choroidal melanoma with plaque brachytherapy. Patients were treated with I-125 plaque brachytherapy with 2 mm margins and 85 Gy to the tumor apex. Consecutive patients were injected intravitreally with 2.5 mg/0.1 mL bevacizumab at a site away from the primary tumor and immediately following plaque removal. Choroidal melanomas were observed using indirect ophthalmoscopy, wide-angle photography, and ultrasound. The main outcome measures were tumor volume, resolution of exudative retinal detachment, and visual acuity.ResultsOne hundred and twenty-four patients met our inclusion criteria and were included in the analysis. The mean patient age was 65.7 years, and the mean apical tumor height was 4.0 ± 2.7 mm and basal diameter was 12.7 ± 3.0 mm. Mean follow-up was 24 months. Prior to treatment, 100% of tumors had exudative retinal detachment, and pretreatment visual acuity was 20/55 (median 20/40). Tumor control was 100%, metastasis was 0% at last follow-up, and 89.8% had complete resolution of exudative retinal detachment, with a mean time to resolution of 3.36 months. At one month, 43% had complete resolution of exudative retinal detachment, which increased to 73% at 4 months. Visual acuity was 20/62 (median 20/40) at 4 months, with stabilization to 20/57 (median 20/40) at 8 months, 20/56 (median 20/30) at 12 months, and 20/68 (median 20/50) at 24 months. Tumor volume following combined therapy was shown to be reduced by 22.2% at 3 months, 28.9% at 6 months, 39.3% at 12 months, and 52.2% at 24 months (all P < 0.001). All patients tolerated the procedure well without systemic side effects.ConclusionIntravitreal bevacizumab may be used as an adjuvant agent following plaque brachytherapy. Treated choroidal melanomas show reduction in tumor volume as well as resolution of exudative retinal detachments.

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“…Because increase in tumor size could reflect continued cellular proliferation, it is usually an indication of treatment failure. 4,5 Other causes for tumor enlargement can occur, however, including hemorrhage or inflammation. Eyes studied histologically after brachytherapy exhibit prominent tumor vessels with signs of vascular damage when compared with choroidal melanomas treated with primary enucleation.…”

Section: Discussionmentioning

confidence: 99%

“…In the Collaborative Ocular Melanoma Study, treatment failure was defined as an increase in height of 15% or 250-mm expansion of any boundary, measured twice in 2 separate examinations. 5 We report a patient whose choroidal melanoma showed significant enlargement 15 years after brachytherapy. When examined histologically, the tumor had changed in size because of markedly dilated vessels (cavernous hemangiomalike) without evidence of renewed neoplastic proliferation.…”

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confidence: 98%