Local Failure After Episcleral Brachytherapy for Posterior Uveal Melanoma: Patterns, Risk Factors, and Management

Bellerive, Claudine; Aziz, Hassan A.; Bena, James; Wilkinson, Allan; Suh, John H.; Plesec, Thomas; Singh, Arun D.

doi:10.1016/j.ajo.2017.01.024

Cited by 25 publications

(10 citation statements)

References 26 publications

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“…The COMS reported a 10.3% rate of local tumor recurrence at 5 years following 125 I brachytherapy [1]. The COMS trials [2] also reported that age over 50 has a nearly 3 times greater risk of recurrence, which was the only risk factor for recurrence identified in our patient; other risk factors include greater apical height and proximity to the fovea [2,10]. Improved rates of local tumor control have been achieved by smaller studies.…”

Section: Discussionmentioning

confidence: 74%

“…Sánchez-Tabernero et al [11] reported a similar mean time to local treatment failure of 3.7 years, with one case recurring 12 years after treatment. In a meta-analysis of 9 studies, Bellerive et al [10] reported that the 5-year local recurrence rate was estimated at 6%.…”

Section: Discussionmentioning

confidence: 99%

“…The vast majority of melanoma recurrences following brachytherapy occur at the tumor margin, particularly the posterior tumor margin, due to plaque placement [4,10,12]. An apical recurrence is less common, especially given that our patient's tumor was <3.5 mm at the time of brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

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Late Apical Recurrence of Choroidal Melanoma 10 Years after Successful Treatment with Brachytherapy

Shih

Corrêa

et al. 2017

Ocul Oncol Pathol

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Purpose: To describe late apical relapse of a choroidal melanoma at the site of fine needle aspiration biopsy 10 years following successful treatment with ¹²⁵I brachytherapy. Methods: Retrospective case report of a 78-year-old male presenting 10 years following successful ¹²⁵I brachytherapy for a choroidal melanoma with a medium-sized nodular amelanotic tumor recurrence at the site of the prior tumor biopsy. Results: Fundus photography and B-scan ultrasound documented the findings at presentation at our institution. The patient was followed closely for 8 weeks while information was retrieved from the treating institution. During this short period, there was significant apical tumor growth. Additionally, there was a clear clinical change compared to the last documented photos from 5 years prior at the treating institution. Enucleation was recommended. Pathological analysis confirmed the diagnosis of recurrent choroidal melanoma at the apex of the treated lesion, at the site of prior biopsy. Systemic surveillance was negative for metastatic disease. Conclusion: Current literature suggests the majority of choroidal melanoma recurrences occur within 5 years following treatment. However, this case of recurrence 10 years after brachytherapy emphasizes the importance of life-long ophthalmic care for these patients. Additionally, this case demonstrates the possibility of a rare recurrence at a prior biopsy site.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Late Apical Recurrence of Choroidal Melanoma 10 Years after Successful Treatment with Brachytherapy

Shih

Corrêa

et al. 2017

Ocul Oncol Pathol

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“…In the studies carried out by other authors, the frequency of relapse after 125 I brachytherapy was 4.5% according to Bellerive et al, 9% according to Perez et al, 4.7% according to Vonk et al and 5.1% according to Sánchez-Tabernero et al [16,17,18,19]. A meta-analysis of 49 papers (a group of 12,524 patients) showed that the risk of local recurrence of uveal melanoma treated with 125 I varies between 4.0% and 9.6% [20].…”

Section: Discussionmentioning

confidence: 87%

Analysis of local recurrence causes in uveal melanoma patients treated with 125I brachytherapy – a single institution study

Kowal¹,

Markiewicz²,

Dębicka-Kumela³

et al. 2019

jcb

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Purpose: To perform a retrospective analysis of factors which might affect the occurrence of a relapse of uveal melanoma after 125 I brachytherapy. Material and methods: The analysis concerned 343 patients treated in the years 2001-2012. The effect on local recurrence of such factors as patient's sex, age, tumour size, shape, pigmentation, location, presence of orange pigment or petechiae on tumour surface, retinal detachment, and blood or dispersed pigment in vitreous body were studied. Additional analysis concerned physical properties of brachytherapy (total dose, irradiation dose applied to tumour apex and base and irradiation time). Two groups of patients were distinguished: with and without a relapse. The diagnostic criterion for the relapse was growth of the tumour base or height by 0.5 mm. Results: Local recurrence of the uveal melanoma was observed in 29 patients (8.5%). Recurrences occurred with significantly higher frequency (p < 0.001), when the anterior tumour edge involved the ciliary body. Patients' survival in relation to the moment the occurrence of the relapse was statistically significant for application time (p = 0.004) and tumour pigmentation (p = 0.010). The deaths of patients with a local relapse were most rare when brachytherapy lasted from 72 to 95.9 hours and most frequent in cases of brownish tumour pigmentation. Patient sex, tumour shape and size, presence of orange pigment, retinal detachment, petechiae and bleeding to vitreous body as well as the dose of irradiation to tumour top and base did not have any significant effect on relapse occurrence. Conclusions: Treatment of uveal melanomas with 125 I applicators allows for a high rate of positive local results. Nonetheless, the recurrence probability always exists. The involvement of the ciliary body could influence this. The survival depending on the time of relapse could be statistically significant for application time and dark-brown tumour pigmentation.

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“…Clinical features and histopathology indicate that the second lesion did not appear to be continuous with the first melanoma in the patient for which a globe enucleation specimen was obtained for histologic examination. Although it is possible that a single uveal melanoma may be diffuse and multinodular with contiguous spread giving the false impression of multifocal melanoma, this is unlikely to be the case in our patients given the location and time interval between presentations, as the recurrences tend to be marginal and occur within the first 5 years after initial treatment [10]. Furthermore, gonioscopy and histological analysis excluded the possibility of occult ring melanoma or contiguous melanoma [11].…”

Section: Discussionmentioning

confidence: 99%

Multifocal Primary Uveal Melanoma: Clinical and Molecular Characteristics

et al. 2018

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We report two patients who developed a second distinct choroidal melanoma in the same eye following successful regression of their first choroidal melanoma after iodine-125 plaque brachytherapy. Neither patient demonstrated ocular melanocytosis, local tumor recurrence, or vitreous seeding. One patient had the second tumor arising from a previously documented choroidal nevus, and after undergoing enucleation, there was no detectable connection between the tumors on histopathologic examination. Germline BAP1 mutation was absent in both cases. Multifocal primary uveal melanoma is a rare entity in which the second tumor may occur either de novo or from a malignant transformation of a choroidal nevus. Known risk factors include ocular melanocytosis or germline BAP1 mutation. Additional underlying mechanisms have yet to be elucidated.

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Local Failure After Episcleral Brachytherapy for Posterior Uveal Melanoma: Patterns, Risk Factors, and Management

Cited by 25 publications

References 26 publications

Late Apical Recurrence of Choroidal Melanoma 10 Years after Successful Treatment with Brachytherapy

Late Apical Recurrence of Choroidal Melanoma 10 Years after Successful Treatment with Brachytherapy

Analysis of local recurrence causes in uveal melanoma patients treated with 125I brachytherapy – a single institution study

Multifocal Primary Uveal Melanoma: Clinical and Molecular Characteristics

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