Complications and adverse events of plaque brachytherapy for ocular melanoma

Peddada, Krishi; Sangani, Roshun; Menon, Hari; Verma, Vivek

doi:10.5114/jcb.2019.87407

Cited by 28 publications

(28 citation statements)

References 54 publications

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“…There is a lack of information regarding local control, metastasis mortality, dose for brachytherapy, and toxicity. Potential adverse events from EPBT include scleral necrosis, strabismus, cataract, glaucoma, and retinopathies [ 24 ]. While PSM was used to reduce selection bias and potential clinical or demographic cofounders, even this analysis cannot completely eliminate confounding biases.…”

Section: Discussionmentioning

confidence: 99%

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

Messer¹,

Zuhour²,

Haque³

et al. 2020

jcb

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Purpose: There is no current randomized data comparing the efficacy of brachytherapy and enucleation for patients with larger sized tumors. The purpose of the present study was to use a large, contemporary database to determine current practice patterns and compare survival outcomes between different management options for patients with choroidal melanoma of various sizes. Material and methods: The National Cancer Database was queried (2004-2014) for histologically-confirmed choroidal melanoma for patients treated with brachytherapy versus enucleation. Chi-square test was used to compare categorized demographic and clinical variables in both arms. Kaplan-Meier analysis evaluated overall survival (OS). Cox proportional hazards assessment determined variables associated with OS. Patients were divided into cohorts representing small, medium, and large tumors. Propensity scores matching (PSM) was utilized to compare more similar cohorts. Results: A total of 7,096 patients met the selection criteria; 5,501 (78%) patients received brachytherapy and 1,595 (22%) patients were treated with enucleation. After PSM, 5-yr OS for small tumors was 87% vs. 64%, for medium tumors was 77% vs. 57%, and for large tumors was 68% vs. 46% for brachytherapy and enucleation, respectively (p < 0.001). Following PSM, multivariate Cox regression found older age (hazard ratio [HR] = 1.76, 95% confidence interval [CI] = 1.51-2.06), more comorbidities (HR = 1.46, 95% CI = 1.25-1.70), extraocular extension (EOE) (HR = 1.25, 95% CI = 1.06-1.48), ciliary body invasion (CBI) (HR = 1.20, 95% CI = 1.02-1.40), and larger size (HR = 1.52, 95% CI = 1.40-1.66) were negative prognosticators of survival. Brachytherapy was a positive prognosticator of survival (HR = 0.45, 95% CI = 0.40-0.51). Conclusions: Patients selected for brachytherapy had improved survival compared to enucleation in all size cohorts. EOE and CBI are significantly higher in the enucleation cohort and are important negative prognosticators for survival selected against patients having brachytherapy. Brachytherapy is a reasonable treatment option for certain patients with large size tumors.

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Section: Discussionmentioning

confidence: 99%

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

Messer¹,

Zuhour²,

Haque³

et al. 2020

jcb

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“…In fact, tumour exudation is a risk factor for permanent visual loss due to apoptotic and necrotic cell death mechanisms leading to significant loss of photoreceptors [ 23 ]. Despite the fact that non-surgical management with intravitreal bevacizumab leads to 73% resolution of ERD [ 32 ], this outcome is obtained at a mean of 4 months from the injection, sufficient time to cause irreversible BCVA deterioration [ 9 ]. The need for prompt surgical treatment of ERD is further confirmed by the risk of developing subretinal fibrosis associated with longstanding detachment [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

Romano

Catania

et al. 2021

IJMS

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Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.

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“…The risk of ocular complications after RT depends on many factors, including the technique, delivered dose, margins, tumor size, and comorbidities. The ocular complications comprise retinopathy, cataracts, maculopathy, vitreous hemorrhage, retinal detachment, strabismus, secondary glaucoma, optic neuropathy, scleral necrosis, uveitis, and others [ 44 ].…”

Section: Radiotherapymentioning

confidence: 99%

New Perspectives for Eye-Sparing Treatment Strategies in Primary Uveal Melanoma

Bilmin

Synoradzki

Czarnecka

et al. 2021

Cancers

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Uveal melanoma is the most common intraocular malignancy and arises from melanocytes in the choroid, ciliary body, or iris. The current eye-sparing treatment options include surgical treatment, plaque brachytherapy, proton beam radiotherapy, stereotactic photon radiotherapy, or photodynamic therapy. However, the efficacy of these methods is still unsatisfactory. This article reviews several possible new treatment options and their potential advantages in treating localized uveal melanoma. These methods may be based on the physical destruction of the cancerous cells by applying ultrasounds. Two examples of such an approach are High-Intensity Focused Ultrasound (HIFU)—a promising technology of thermal destruction of solid tumors located deep under the skin and sonodynamic therapy (SDT) that induces reactive oxygen species. Another approach may be based on improving the penetration of anti-cancer agents into UM cells. The most promising technologies from this group are based on enhancing drug delivery by applying electric current. One such approach is called transcorneal iontophoresis and has already been shown to increase the local concentration of several different therapeutics. Another technique, electrically enhanced chemotherapy, may promote drug delivery from the intercellular space to cells. Finally, new advanced nanoparticles are developed to combine diagnostic imaging and therapy (i.e., theranostics). However, these methods are mostly at an early stage of development. More advanced and targeted preclinical studies and clinical trials would be needed to introduce some of these techniques to routine clinical practice.

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Complications and adverse events of plaque brachytherapy for ocular melanoma

Cited by 28 publications

References 54 publications

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

New Perspectives for Eye-Sparing Treatment Strategies in Primary Uveal Melanoma

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