Brachytherapy vs. external beam radiotherapy for choroidal melanoma: Survival and patterns-of-care analyses

Abrams, Matthew; Gagne, Nolan L.; Melhus, Christopher S.; Mignano, John E.

doi:10.1016/j.brachy.2015.12.001

Cited by 24 publications

(22 citation statements)

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“…More recently, the use of external beam radiation (EBRT), including Gamma Knife radiosurgery and proton beam radiotherapy has been increasingly investigated, with variable success 50. Abrams et al50 conducted a retrospective SEER study involving 1,004 UM patients (380 treated with EBRT and 624 treated with brachytherapy) and reported no difference in 5-year overall survival (83.3% vs 82.5%, P =0.69) and 5-year cause-specific survival (88.3% vs 88.3%, P =0.92) between EBRT and brachytherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Abrams et al50 conducted a retrospective SEER study involving 1,004 UM patients (380 treated with EBRT and 624 treated with brachytherapy) and reported no difference in 5-year overall survival (83.3% vs 82.5%, P =0.69) and 5-year cause-specific survival (88.3% vs 88.3%, P =0.92) between EBRT and brachytherapy. On multivariate analysis, however, the treatment of lower T-stage tumors favored brachytherapy, whereas higher T-stage tumors favored EBRT 50. This is likely attributable to the difficulty in delivering prescriptive dose to advanced stage tumors 50.…”

Section: Discussionmentioning

confidence: 99%

“…On multivariate analysis, however, the treatment of lower T-stage tumors favored brachytherapy, whereas higher T-stage tumors favored EBRT 50. This is likely attributable to the difficulty in delivering prescriptive dose to advanced stage tumors 50. In a Cox proportion hazards regression analysis, Andreoli et al51 identified that tumor histology, stage, and age at diagnosis were associated with disease-specific survival.…”

Section: Discussionmentioning

confidence: 99%

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Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973–2012)

Mahendraraj

Lau

Lee

et al. 2016

OPTH

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IntroductionUveal melanoma (UM) is the most common primary intraocular malignancy, despite comprising <5% of all melanomas. To date, relatively few case series of UM have been published. Moreover, the factors influencing survival remain largely unknown. This study sought to analyze the impact of demographics, histology, clinical presentation, and treatments on the clinical outcomes of UM in a large modern nationwide patient cohort.MethodsDemographics and clinical data were abstracted on 277,120 histologically confirmed melanoma patients from the Surveillance, Epidemiology, and End Results database between 1973 and 2012.ResultsA total of 7,516 cases of UM represented 3.2% of all recorded cases of melanoma. The mean age-adjusted incidence was 5.1 per million (95% CI 4.2–6.1) and was higher in males (5.9, CI =4.4–7.6) compared to females (4.5, CI =3.3–5.8), P<0.001. UM occurred most commonly in the sixth decade of life (61.4±15) and among Caucasians (94.7%). A total of 52.3% of cases were reported in the Western US (35.7% in California). The initial diagnoses in 65.2% of cases were by histopathology, followed by clinical diagnosis (18.8%) and radiographic imaging (16.0%). The percentage of UM cases managed by surgery alone decreased by 69.4% between the 1973–1977 and 2006–2012 time periods, concomitant with a 62% increase in primary radiotherapy, P<0.001. The UM mean overall and cancer-specific 5-year relative survival rates were 79.8%±5.8% and 76%±5.3%, respectively. The mean 5-year cancer-specific survival rate (76%) remained stable during the study period between 1973 and 2012. The mean survival for patients treated with primary radiotherapy was significantly improved compared to those treated with surgery alone (15.4±0.4 vs 13.6±0.3, P<0.001). Multivariate analysis identified male sex (odds ratio [OR] 1.1, CI =1.0–1.3), age >50 years (OR 4.0, CI =3.4–4.6), distant metastases (OR 8.6, CI =4.7–15), and primary surgical treatment (OR 2.6, CI =2.0–3.3) as independently associated with increased mortality, P<0.005. Conversely, patients identified as Hispanic (OR 0.6, CI =0.5–0.8) and patients receiving radiation treatment (OR 0.5, CI =0.4–0.7) were independently associated with reduced mortality, P<0.005.ConclusionUM remains a rare form of melanoma that occurs primarily in Caucasian patients older than 50 years. More than two-thirds of UM patients are curatively treated with primary radiotherapy as opposed to surgery, which has resulted in a significant improvement in both overall survival and cancer-specific survival. Despite this shift in management strategy, the mean 5-year cancer-specific survival rate remained relatively unchanged during the study period. Male sex, older age, distant disease, and primary surgical therapy rather than radiotherapy are associated with an increased risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973–2012)

Mahendraraj

Lau

Lee

et al. 2016

OPTH

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 99%

“…Techniques such as proton beam radiotherapy and gamma knife radiosurgery have been increasingly investigated, with variable success 29. In a SEER study involving 1,004 UM patients, Abrams et al reported similar 5-year overall survival (83.3% vs 82.5%, P =0.69) and 5-year cause-specific survival (88.3% vs 88.3%, P =0.92) with EBRT and brachytherapy 29. Brachytherapy appeared more beneficial for early stage tumors, whereas EBRT was more favorable in late stage tumors, likely because it is more difficult to deliver prescriptive doses to tumors of advanced stages 29…”

Section: Discussionmentioning

confidence: 99%

Ocular melanoma-when you have seen one, you have not seen them all: a clinical outcome study from the Surveillance, Epidemiology and End Results (SEER) database (1973–2012)

Mahendraraj¹,

Shrestha²,

Lau³

et al. 2017

OPTH

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BackgroundOcular melanoma (OM) comprises <5% of all melanomas. Uveal melanoma (UM) is the most common subtype of OM, while conjunctival melanoma (CM) is rare and differs significantly from UM. The purpose of this study is to evaluate a large cohort of OM patients to differentiate demographic, pathologic, and clinical factors between these two neoplasms, which may affect treatment and outcomes.MethodsThe Surveillance, Epidemiology, and End Results database (1973–2012) was used to extract demographic and clinical data on 8,165 OM patients (92.1% UM and 7.9% CM).ResultsBoth CM and UM were most prevalent among Caucasian males in the seventh decade of life. UM patients presented more often with localized disease (90.9% vs 81.2, P<0.01). Surgery (42.8%), radiation (43.0%), or combined surgery and radiation (7.0%) were used in the treatment of UM, while CM was treated almost exclusively with surgery (88.7%). Mean overall survival was longer (15.4 vs 14.6 years; P<0.01) and mortality rates were lower in patients (38.8% vs 46.1%; P<0.01) with CM.ConclusionDespite presenting with more advanced disease than UM, CM is associated with an increased overall survival. Surgery is the primary therapy for CM, whereas radiotherapy is the primary therapy for UM and is associated with prolonged survival.

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Uveal Melanoma

Milam¹,

Daniels²

2018

Melanoma

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Brachytherapy vs. external beam radiotherapy for choroidal melanoma: Survival and patterns-of-care analyses

Cited by 24 publications

References 42 publications

Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973–2012)

Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973–2012)

Ocular melanoma-when you have seen one, you have not seen them all: a clinical outcome study from the Surveillance, Epidemiology and End Results (SEER) database (1973–2012)

Uveal Melanoma

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Brachytherapy vs. external beam radiotherapy for choroidal melanoma: Survival and patterns-of-care analyses

Cited by 24 publications

References 42 publications

Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973&ndash;2012)

Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973&ndash;2012)

Ocular melanoma-when you have seen one, you have not seen them all: a clinical outcome study from the Surveillance, Epidemiology and End Results (SEER) database (1973&ndash;2012)

Uveal Melanoma

Contact Info

Product

Resources

About

Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973–2012)

Trends in incidence, survival, and management of uveal melanoma: a population-based study of 7,516 patients from the Surveillance, Epidemiology, and End Results database (1973–2012)

Ocular melanoma-when you have seen one, you have not seen them all: a clinical outcome study from the Surveillance, Epidemiology and End Results (SEER) database (1973–2012)