The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma

Jampol, Lee M.; Moy, Claudia S.; Murray, Timothy G.; Reynolds, S. R. M.; Albert, Daniel M.; Schachat, Andrew P.; Diddie, Kenneth R.; Engstrom, Robert E.; Finger, Paul T.; Hovland, Kenneth R.; Joffe, Leonard; Olsen, Karl R.; Wells, Craig G.

doi:10.1016/s0161-6420(02)01277-0

Cited by 315 publications

(115 citation statements)

References 27 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%

“…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]. These data established iodine-125 brachytherapy as the gold standard for treating medium-sized uveal melanoma with the 5-year risk of local treatment failure of 10.3% [17]. Published studies have suggested that local recurrence increases the potential for metastasis [18,19,20,21].…”

Section: Introductionmentioning

confidence: 99%

“…The lack of evidence regarding optimal plaque radiation dose presents an opportunity to investigate whether doses lower than the COMS standard of 85.0 Gy to the tumor apex would provide a comparable therapeutic profile with a non-inferior local control rate [17]. To our knowledge, there has been no systematic review of retrospective or prospective clinical studies evaluating the relationship between dose to tumor apex and local recurrence rates of patients with uveal melanoma treated with iodine-125 brachytherapy.…”

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%

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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“…Radiation-induced neovascular glaucoma is particularly bothersome and is one of the main reasons for enucleation following plaque radiotherapy, especially more than 3 years after radiotherapy. 17 Multivariate analysis of the COMS data (Collaborative Ocular Melanoma Study) revealed that initial tumour height is the strongest predictor of enucleation following plaque radiotherapy, with a risk ratio of 2.4 (95% CI, 1.3-4.2) for tumours more than 5.0 mm in height. 17 In this issue, Kıratlı and Bilgiç 18 report an unusual complication of secondary glaucoma due to pigment dispersion in eyes with uveal melanoma that were treated with Iodine 125 plaque radiotherapy.…”

mentioning

confidence: 99%

“…17 Multivariate analysis of the COMS data (Collaborative Ocular Melanoma Study) revealed that initial tumour height is the strongest predictor of enucleation following plaque radiotherapy, with a risk ratio of 2.4 (95% CI, 1.3-4.2) for tumours more than 5.0 mm in height. 17 In this issue, Kıratlı and Bilgiç 18 report an unusual complication of secondary glaucoma due to pigment dispersion in eyes with uveal melanoma that were treated with Iodine 125 plaque radiotherapy. They attributed glaucoma to tumour lysis, solely based on clinical findings, as it was associated with pigment dispersion in the aqueous and vitreous and apparent blockage of the trabecular meshwork.…”

mentioning

confidence: 99%