Treatment of Uveal Melanoma With Radioactive Iodine 125 Implant Compared With Proton Beam Radiotherapy

Bolling, James P.; Dagan, Roi; Rutenberg, M.S.; Mamalui‐Hunter, M; Buskirk, Steven J.; Heckman, Michael G.; Hochwald, Alexander P.; Slopsema, R

doi:10.1016/j.mayocpiqo.2021.10.002

Cited by 8 publications

(1 citation statement)

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“…A higher radiation dose to adjacent tissue may induce a higher probability of NVG [ 19 , 20 ], but whether it increases the incidence of NVG-related enucleation in the whole irradiated population is still unclear. Other modalities of radiation therapy(charged particle radiotherapy and stereotactic radiotherapy) also failed to escape from secondary glaucoma [ 21 – 23 ] and led to similar [ 23 ] even higher incidence [ 24 , 25 ]. NVG, the main reason for secondary enucleation in our cohort, should be closely monitored throughout follow-up.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of secondary enucleation for uveal melanoma after plaque radiotherapy

et al. 2022

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Background Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. Plaque brachytherapy (PRT) is widely accepted as an effective globe-conserving treatment modality for UM. However, local treatment failure and complications lead to the enucleation of irradiated eyes. We conducted this study to explore the causes and long-term prognosis for UM patients who accepted secondary enucleation after plaque radiotherapy. Methods This was a retrospective cohort study. Data of patients who underwent secondary enucleation for UM after plaque radiotherapy, from July 2007 to July 2019, at Beijing Tongren Hospital were analyzed. Kaplan–Meier analysis was performed to assess the probability of indications, metastasis, and metastasis-related death. Cox regression analysis was used to analyze associations of the prognostic factors. Results Eight hundred and eighty patients were clinically diagnosed with uveal melanoma and initially treated by iodine-125 plaque radiotherapy, 132 of whom underwent secondary enucleation and pathological examination in the same hospital. Fifty-two (39.4%) eyes were enucleated simply because of uncontrollable neovascular glaucoma (NVG). Forty-four (33.3%) patients suffered from tumor recurrence. Tumor non-response occurred in 18 (13.6%) cases. Ten (7.6%) eyes received enucleation entirely due to other types of glaucoma. Failure to preserve the eyes for other reasons occurred in eight (6.1%) patients. At a median follow-up of 58.1 [IQR: 40.9–90.5] months, the systemic spread was detected in 45 (34.1%) patients, and 38 of them died. On multivariate analysis, tumor largest basal diameter (HR 1.15 [95% CI: 1.01, 1.31]), tumor non-response (HR 7.22 [95% CI: 2.63, 19.82]), and recurrence (HR 3.29 [95% CI: 1.54, 7.07]) were risk factors for metastasis. Increased age (HR 1.54 [95% CI: 1.07, 2.23]), tumor non-response (HR 7.91 [95% CI: 2.79, 22.48]), and recurrence (HR 3.08 [95% CI: 1.13, 7.23]) were risk factors for metastasis-related death. Conclusions NVG was the major reason for secondary enucleation for Chinese UM patients after PRT. Tumor non-response and recurrence were associated with a significantly higher risk of long-term metastasis and metastasis-related death.

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