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

Abstract

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.

Brachytherapy or enucleation in ring melanoma patients: which is better? Preliminary results of the authors’ own experiences

“…Therefore, local treatments other than enucleation, such as eye plaque brachytherapy, should be safe and efficient in patient's vision and aesthetics preservation. Their findings suggest that eye plaque brachytherapy is a reasonable treatment option for all size ocular melanoma tumors, even large size tumors [28]. The above observation may also confirm our results, such as the lack of differences in OS and CSOS, irrespectively of the ring melanoma treatment manner.…”

Staged Eye-Plaque Brachytherapy: A Novel Approach for Large Uveal Melanoma

“… 5 A recent large national retrospective study showed that large uveal melanoma treated with EPBT had comparable survival to enucleation. 6 Genomic data supports this assertion, in that micrometastases have typically already occurred in patients who present with large tumors with aggressive genetic signatures. 7 Additionally, 2 prior retrospective studies evaluating EPBT for large uveal melanoma showed acceptable local failure rates (6%-9%) at 5 years.…”

“…Although current American Brachytherapy Society (ABS) guidelines stipulate that EPBT may be used for large uveal melanoma if basal diameters do not exceed the limits of brachytherapy and there is ≤5 mm extraocular extension, there are no randomized controlled trials comparing EPBT to enucleation for large uveal melanoma (5). A recent large national retrospective study showed that large uveal melanoma treated with EPBT had comparable survival to enucleation (6).…”

Radiobiological evaluation of organs at risk for electronic high-dose-rate brachytherapy in uveal melanoma: a radiobiological modeling study

“…Treatment of uveal melanomas includes enucleation or radiation therapy. Radiation therapy may be delivered either via brachytherapy (BT) [4][5][6][7][8][9][10][11][12][13][14][15][16][17], external beam radiation therapy (EBRT), using proton beams or stereotactic radiosurgery with Gamma knife (Elekta Instruments, Stockholm, Sweden). Outcomes [18] are reported in terms of survival, metastases, recurrence, and visual acuity, but there are few EBRT results that include doses to OARs within the optical apparatus [19][20][21].…”

“…Iodine-125-based eye plaque low-dose-rate BT ( 125 I LDR-BT) has proven to provide superior vision retention and equivalent tumor control over conventional enucleation for ocular melanomas [10,[22][23][24]. However, its delivery typically takes 5 days, with a dose-rate of 0.35-0.83 Gy/h.…”