Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma

Shields, Carol L.; Dalvin, Lauren A; Chang, Michael; Mazloumi, Mehdi; Fortin, P; McGarrey, Mark P.; Martin, Andrei; Yaghy, Antonio; Yang, Xiaolu; Vichitvejpaisal, Pornpattana; Mashayekhi, Arman; Shields, Jerry A.

doi:10.1001/jamaophthalmol.2019.5132

Cited by 46 publications

(73 citation statements)

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“…FSRT centres report for 24.5-42% [7,22]. A point of attention is that almost 60% of the current study population was in the era before anti-vascular endothelial growth factor (VEGF) intravitreal injections, which could explain the high percentage of neovascular glaucoma in both groups, and with the current treatment options with anti-VEGF we may expect less neovascular glaucoma, however, this has to be evaluated in a prospective study [28]. A tumour within 3 mm of the optic nerve would result in a high dose of radiation of the optic nerve and consequently would lead to a decrease in visual acuity.…”

Section: Discussionmentioning

confidence: 97%

“…After radiation, high doses of VEGF are found in the eye [33]. The treatment of anti-VEGF intravitreal injections seems to limit visual loss associated with radiation maculopathy, although this was analysed after a different form of radiation treatment with plaque therapy [28,34]. Shields et al observed a decrease in radiation maculopathy with preservation of visual acuity after prophylactic Bevacizumab every four months [28].…”

Section: Discussionmentioning

confidence: 99%

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Local tumour control and radiation side effects for fractionated stereotactic photon beam radiotherapy compared to proton beam radiotherapy in uveal melanoma

Beek¹,

Ramdas²,

Angi

et al. 2021

Radiotherapy and Oncology

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Local tumour control and radiation side effects for fractionated stereotactic photon beam radiotherapy compared to proton beam radiotherapy in uveal melanoma

Beek¹,

Ramdas²,

Angi

et al. 2021

Radiotherapy and Oncology

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“…Clinical evidence of radiation maculopathy at month 24 was seen in 8 of 24 (33%) patients with small/medium tumours vs 42 of 62 (68%) of controls ( P = .004). 20 In a recent study on radiation complications and visual outcome in 1131 patients with uveal melanoma managed with plaque radiotherapy and post‐radiotherapy prophylactic intravitreal bevacizumab, Shields et al found the bevacizumab group had less OCT‐evident CME at 4 months ( P = .002), 24 months ( P = .02) and 36 months ( P = .01); less clinically evident radiation maculopathy at 24 months ( P = .03), 36 months ( P = .01) and 48 months ( P = .03); and less clinically evident radiation papillopathy at 4 months ( P = .02) and 18 months ( P = .04) compared to the non‐bevacizumab group 21 . These findings correlated with better visual outcomes in the bevacizumab group at 4 months (0.18 [20/30] vs 0.30 [20/40], P = .04), 12 months (0.30 [20/40] vs 0.48 [20/60], P = .02), 18 months (0.40 [20/50] vs 0.70 [20/100], P = .003), 24 months (0.40 [20/50] vs 0.70 [20/100], P < .001), 36 months (0.48 [20/60] vs 1.00 [20/200], P = .003) and 48 months (0.54 [20/70], vs 2.00, [counting fingers], P < .001) compared to controls 21 …”

Section: Discussionmentioning

confidence: 98%

Impact of uveal melanoma thickness on post‐plaque radiotherapy outcomes in the prophylactic anti‐vascular endothelial growth factor era in 1131 patients

Yang

Dalvin

Mazloumi

et al. 2020

Clinical Exper Ophthalmology

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Importance The impact of tumour thickness on radiation complications following plaque radiotherapy for uveal melanoma in the anti‐vascular endothelial growth factor (VEGF) era remains unknown. Background To evaluate treatment outcomes following plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma based on initial tumour thickness. Design This was a retrospective, interventional case series. Participants Patients with uveal melanoma were included in this study. Methods A review of medical records was conducted of patients with uveal melanoma treated with plaque radiotherapy and prophylactic intravitreal bevacizumab from 7 July 2000 to 2 November 2018. Main outcomes measures Radiation‐related outcomes of cystoid macular oedema (CME), radiation maculopathy, papillopathy, retinopathy, iris neovascularization (NVI) and neovascular glaucoma (NVG) were compared based on tumour thickness (small [<3.0 mm] vs medium [3.1‐8.0 mm] vs large [>8.0 mm]). Results Of 1131 eyes, 341 (30%) had small, 633 (56%) medium and 157 (14%) large melanoma. Comparison (small vs medium vs large) at 4 years following radiotherapy revealed large melanoma with greater Kaplan‐Meier estimated risk of CME (37% vs 37% vs 63%, P < .001), earlier onset of CME (33 vs 26 vs 19 months, P < .001) and greater development of NVI (<1% vs 2% vs 13%, P < .001) and NVG (1% vs 2% vs 12%, P < .001). Radiation‐induced maculopathy, papillopathy and retinopathy were not associated with tumour thickness. Conclusions and relevance Compared with small and medium uveal melanoma, large uveal melanoma demonstrated greater 48‐month risk for CME, shorter time to CME onset and greater development of NVI and NVG following plaque radiotherapy and prophylactic intravitreal bevacizumab.

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“…16 Damage to these structures can result in various radiation complications, including dry eye, corneal ulceration, a cataract, iris neovascularization, neovascular glaucoma, and radiation maculopathy, retinopathy, and papillopathy. 17,18 Radiation physicists often add 1 mm to the ocular oncologist's prescribed radiation depth to account for scleral thickness. If the sclera is already included in the measurement of the tumor, this can lead to overtreatment.…”

Section: Discussionmentioning

confidence: 99%

Conversion Factor for B‐Scan Ultrasound Measurement of Intraocular Tumors With and Without the Sclera

Tanke

Dalvin

2020

J of Ultrasound Medicine

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Objectives-To investigate the relationship between choroidal nevus and melanoma thickness measured with or without the sclera included by B-scan ultrasound and to present a simple conversion formula.Methods-Medical records were retrospectively reviewed for choroidal nevus or melanoma evaluated at the Mayo Clinic in Rochester, Minnesota, with B-scan ultrasound between February 4, 2004, and April 23, 2020. Charts were retrospectively reviewed for high-quality B-scan images in which the ultrasound transducer was perpendicular to the lesion, measuring the tumor thickness without the sclera included. Measurements were repeated with the sclera included for each patient. Univariate and multiple linear regression analyses were performed to identify factors correlated with scleral thickness.Results-There were 201 tumors included in the study, with a mean patient age AE SD of 61 AE 14 years, largest tumor basal diameter of 11.8 AE 4.8 mm, tumor thickness without the sclera included of 3.72 AE 2.7 mm, and thickness with the sclera included of 4.54 AE SD 2.8 mm. On the univariate analysis, factors associated with perceived scleral thickness by B-scan ultrasound included age (P < .001), tumor thickness (P < .001), and basal diameter (P = .06). On the multivariate analysis, factors associated with perceived scleral thickness included age and tumor thickness (P < .001) for all tumors and for the subset of 141 tumors with a thickness of 2 mm or greater (P < .001). For tumors of 2 mm or greater in thickness, perceived scleral thickness by ultrasound can be estimated by the formula 0.00495(patient age) + 0.02451(tumor thickness without the sclera) + 0.42549.Conclusions-We present a simple formula for converting between B-scan ultrasound measurements of choroidal nevus and melanoma measuring 2 mm or greater in thickness with and without the sclera included.

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Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma

Cited by 46 publications

References 21 publications

Local tumour control and radiation side effects for fractionated stereotactic photon beam radiotherapy compared to proton beam radiotherapy in uveal melanoma

Local tumour control and radiation side effects for fractionated stereotactic photon beam radiotherapy compared to proton beam radiotherapy in uveal melanoma

Impact of uveal melanoma thickness on post‐plaque radiotherapy outcomes in the prophylactic anti‐vascular endothelial growth factor era in 1131 patients

Conversion Factor for B‐Scan Ultrasound Measurement of Intraocular Tumors With and Without the Sclera

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