Outcomes of Choroidal Melanomas Treated With Eye Physics

Berry, Jesse L.; Dandapani, Savita; Stevanovic, Marta; Lee, Thomas C.; Astrahan, Melvin A.; Murphree, A. Linn; Kim, Jonathan W.

doi:10.1001/jamaophthalmol.2013.4422

Cited by 50 publications

(41 citation statements)

References 18 publications

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“…Fourteen studies were retrospective clinical chart reviews [14,15,22,23,24,25,26,27,28,29,30,31,32], and 1 was a prospective, randomized trial, the COMS trial [17]. One retrospective study included patients from the COMS trial [15].…”

Section: Resultsmentioning

confidence: 99%

“…This dose was adjusted (originally 100.0 Gy) after the Task Group (TG 43) protocol was adopted by the American Association of Physicists in Medicine [12]. The dose of 85.0 Gy for the COMS trial was selected based upon expert consensus [9,11,13,14,15]. The COMS study showed that an eye-preserving, and potentially a vision-preserving, therapeutic regimen with iodine-125 plaque brachytherapy had a non-inferior mortality risk compared to enucleation up to 12 years following treatment [16].…”

Section: Introductionmentioning

confidence: 99%

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Iodine-125 Brachytherapy for Uveal Melanoma: A Systematic Review of Radiation Dose

et al. 2017

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Aim: To investigate whether lower radiation doses may yield similar outcome measures to those from the COMS trial. Methods: A literature review of English language articles was performed using the PubMed database of the U.S. National Library of Medicine and the Cochrane Central Register of Controlled Trials using the following keywords: uveal melanoma, choroidal melanoma, primary uveal malignant melanoma, iodine-125 brachytherapy, local recurrence, local treatment failure, and local tumor control. The relationships between study local recurrence rate and median dosage were tested by linear regression, with each study weighted by the number of patients included. Results: Fifteen retrospective and prospective studies were selected for systematic review (2,662 patients). Ranges of reported mean or median radiation dose to tumor apex were 62.5-104.0 Gy. Local recurrence rates ranged from 0 to 24%. A 1.0-Gy increase in the average study dose was associated with a 0.14% decrease in local recurrence rate, which was not statistically significant (p value 0.336). Conclusion: The gold standard empirically derived 85.0-Gy radiation dose for the treatment of uveal melanoma could be tested in a randomized study.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Iodine-125 Brachytherapy for Uveal Melanoma: A Systematic Review of Radiation Dose

et al. 2017

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“…Prior studies suggest that following brachytherapy there is often greater than 90% local tumor control for choroidal melanomas [1,7,8,9], with recurrence rates ranging from 0 to 18% [3,7]. The COMS reported a 10.3% rate of local tumor recurrence at 5 years following 125 I brachytherapy [1].…”

Section: Discussionmentioning

confidence: 99%

“…Improved rates of local tumor control have been achieved by smaller studies. A series by the University of Southern California, using 3D imaging for plaque planning, achieved a local tumor control rate of 97% at 5 years [8]. Another study used intraoperative ultrasound guidance for brachytherapy, and found a statistically lower rate of 2-year local treatment failure than the COMS trial [9].…”

Section: Discussionmentioning

confidence: 99%

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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“…Large tumour size and proximity to the optic nerve or fovea are associated with the loss of vision owing to radiation-induced retinopathy, optic neuropathy, maculopathy, and secondary glaucoma. [3][4][5][6] Transscleral resection (TSR) has been described as a primary procedure to treat uveal melanoma in patients who are not expected to have good outcomes after conventional brachytherapy. [7][8][9] Some studies [7][8][9] suggest that TSR may achieve better vision preservation than IBT while avoiding many of the complications associated with brachytherapy.…”

Section: Introductionmentioning

confidence: 99%

Transscleral resection without hypotensive anaesthesia vs iodine-125 plaque brachytherapy in the treatment of choroidal melanoma

Caminal

Padrón-Pérez

Arias

et al. 2016

Eye

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Aims The aim of this study was to compare transscleral resection technique performed without hypotensive anaesthesia (TSRWH) with iodine-125 brachytherapy (IBT) in the treatment of choroidal melanoma. Patients and methods This was a retrospective surgical cohort study. Nineteen eyes treated with TSRWH were matched with 53 eyes treated with IBT according to: tumour size, distance to fovea, distance to optic nerve, and follow-up time. Best-corrected visual acuity (BCVA), local recurrence, secondary enucleation, metastasis, overall and specific survival, and complications were evaluated. Results Patients treated with TSRWH had significantly better BCVA than those treated with IBT. The local recurrence risk was significantly higher when ciliary body was involved (HR = 11.4, 95% CI 2.24-49.7, P = 0.04). Metastatic disease was observed in 14 of 53 patients (26.4%) in the IBT group vs 3 patients (15.8%) in the TSRWH group (P = 0.531). Multivariate analysis showed that iris involvement (HR = 16.0, 95% CI 4.2-170.2, P = 0.033) and large tumour (HR = 2.3, 95% CI 1.2-4.8, P = 0.04) increased the probability of metastasis. During follow-up, six patients (11.3%) in IBT group died vs two (10.5%) in the TSRWH group (P ≥ 0.999). Nine patients required secondary enucleation: 5 (9.4%) in the IBT group vs 4 (21.1%) in the TSRWH group (P = 0.231). The most common complications in IBT group were radiationinduced retinopathy (45.3%), neovascular glaucoma (28.3%), and macular oedema (24.5%), whereas rhegmatogenous retinal detachment (21.1%), ocular hypertension (21.1%), and submacular haemorrhage (15.8%) were the most frequent complications after TSRWH. Conclusion TSRWH is a technically challenging procedure. However, when performed successfully, this technique achieves better preservation of visual acuity than IBT and without the limitations inherent in hypotensive anaesthesia.

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Outcomes of Choroidal Melanomas Treated With Eye Physics

Cited by 50 publications

References 18 publications

Iodine-125 Brachytherapy for Uveal Melanoma: A Systematic Review of Radiation Dose

Iodine-125 Brachytherapy for Uveal Melanoma: A Systematic Review of Radiation Dose

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

Transscleral resection without hypotensive anaesthesia vs iodine-125 plaque brachytherapy in the treatment of choroidal melanoma

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