Estimates of Ocular and Visual Retention Following Treatment of Extra-Large Uveal Melanomas by Proton Beam Radiotherapy

Conway, R Max; Poothullil, Antony M.; Daftari, Inder K.; Weinberg, Vivian; Chung, Juliet E.; O’Brien, Joan M.

doi:10.1001/archopht.124.6.838

Cited by 59 publications

(60 citation statements)

References 25 publications

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“…In a previous study, Conway et al [22 ]evaluated ocular retention and visual retention following PBRT in 21 extralarge uveal melanomas. Compared with the present study, choroidal melanomas had a smaller mean tumour thickness (8.6 mm), a larger mean tumour basal diameter (18.7 mm) and ciliary body melanomas were also included.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes for Patients with Large Choroidal Melanoma after Primary Treatment with Enucleation or Proton Beam Radiotherapy

et al. 2012

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Purpose: To evaluate survival and clinical outcome for patients with a large uveal melanoma treated by either enucleation or proton beam radiotherapy (PBRT). Procedures: This retrospective non-randomized study evaluated 132 consecutive patients with T3 and T4 choroidal melanoma classified according to TNM stage grouping. Results: Cumulative all-cause mortality, melanoma-related mortality and metastasis-free survival were not statistically different between the two groups (log-rank test, p = 0.56, p = 0.99 and p = 0.25, respectively). Eye retention of the tumours treated with PBRT at 5 years was 74% (SD 6.2%). In these patients at diagnosis, 73% of eyes had a best-corrected visual acuity (BCVA) of 0.1 or better. After 12 and 60 months, BCVA of 0.1 or better was observed in 47.5 and 32%, respectively. Conclusion and Message: Although enucleation is the most common primary treatment for large uveal melanomas, PBRT is an eye-preserving option that may be considered for some patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes for Patients with Large Choroidal Melanoma after Primary Treatment with Enucleation or Proton Beam Radiotherapy

et al. 2012

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“…Necrosis after plaque brachytherapy of any kind for malignant intraocular tumors has been reported in 0-33% of patients [1,2,3,4,5]. For uveal melanomas treated with 125 I brachytherapy, necrosis was seen in 11% of patients with predominantly ciliary body involvement [2], while Shields et al [3] reported necrosis in 7% at 5 years and 9% at 10 years in patients with large posterior uveal melanomas.…”

Section: Discussionmentioning

confidence: 99%

“…Scleral necrosis is a known complication of plaque radiotherapy for uveal melanoma, with a reported incidence of 0-33% [1,2,3,4,5]. Proposed mechanisms include a direct necrotizing effect of radiation on the sclera, a secondary effect due to local ischemic inflammation from muscle disinsertion, inflammation related to tumor necrosis, regression of the tumor with undiagnosed scleral invasion, and an occult systemic autoimmune phenomenon [2,4,6].…”

Section: Introductionmentioning

confidence: 99%

Extrascleral Tumor Extension Associated with Localized Scleral Melt following Plaque Brachytherapy for Uveal Melanoma: Clinical and Histologic Findings

2017

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Background/Aims: Our study aims to better characterize the clinical and histopathologic features of eyes with extrascleral uveal melanoma associated with scleral melt following brachytherapy. Methods: A retrospective review was performed on patients who had undergone ¹²⁵I (iodine-125) brachytherapy for uveal melanoma at our institution between 1992 and 2015. Patients with postradiation scleral necrosis who required enucleation were identified, and an analysis including a review of histopathology results was performed on those cases. Results: A total of 301 patients underwent plaque brachytherapy for uveal melanoma, of whom 31 required eventual enucleation. The histologic analysis showed extraocular extension through full-thickness scleral discontinuities in 6 cases. All but 1 (5 of 6) of these eyes exhibited either mitotic figures or Ki-67 positivity. Mitotic figures were noted in 4 specimens, including 3 eyes exhibiting mitoses within or adjacent to the extrascleral portion of the tumor. Two eyes exhibiting mitoses, as well as the case with Ki-67 positivity, also had clinical evidence of tumor regrowth. Conclusion: We found evidence of mitotic activity at the area of scleral discontinuity in some eyes with and in some without clinical evidence of tumor regrowth. Protruding pigmented material in areas of scleral necrosis after plaque brachytherapy may represent actively proliferating tumors even without internal evidence of tumor regrowth.

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“…In our study, the neovascular glaucoma rate was 20%, which was not higher than reported in the literature for uveal melanoma in general. As mentioned above, exudative retinal detachment is a risk factor for neovascular glaucoma, which is the leading cause for enucleation [2,4,10,11,12,13]. Therefore, it would be interesting to perform VEGF measurements before and after vitrectomy to show that perhaps by reattachment of the retina, levels of VEGF are lowered to the same levels as in uveal melanoma in general.…”

Section: Discussionmentioning

confidence: 99%

“…Functional outcomes depend inversely on the lag duration between retinal detachment and reattachment. Furthermore, exudative retinal detachment is a risk factor for neovascular glaucoma possibly leading to enucleation with no influence on survival rates [2,4,10,11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

et al. 2014

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Background: Choroidal melanoma is frequently accompanied by an exudative retinal detachment that can persist after proton beam therapy. This study investigates whether vitrectomy without tumor resection improves the clinical outcome. Methods: This is a retrospective interventional case series. Twenty patients with choroidal melanoma with exudative retinal detachment involving the macula were treated by vitrectomy, endodrainage, photocoagulation, and silicone oil tamponade after proton beam therapy. Results: The mean follow-up was 38.4 months (median 21.5, range 12.0-122.0). The mean time between proton beam therapy and surgery was 4.5 months (range 0.1-9.2). Reattachment was achieved in 95% of the patients after one vitrectomy. One patient was lost to follow-up because enucleation was performed after 45.9 months due to a secondary glaucoma. Mean visual acuity decreased from 1.1 to 1.8 logMAR before vitrectomy and after 4 years, respectively. No patient showed local tumor recurrence. Metastatic disease was present in 1 patient after 15.2 months, and this patient died after 19.2 months. Conclusion: Vitrectomy is indicated after therapeutic proton beam irradiation in patients who present with persisting exudative retinal detachment involving the macula and high local or systemic risk factors for hemorrhagic complications, thus excluding endoresection.

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Estimates of Ocular and Visual Retention Following Treatment of Extra-Large Uveal Melanomas by Proton Beam Radiotherapy

Cited by 59 publications

References 25 publications

Comparison of Clinical Outcomes for Patients with Large Choroidal Melanoma after Primary Treatment with Enucleation or Proton Beam Radiotherapy

Comparison of Clinical Outcomes for Patients with Large Choroidal Melanoma after Primary Treatment with Enucleation or Proton Beam Radiotherapy

Extrascleral Tumor Extension Associated with Localized Scleral Melt following Plaque Brachytherapy for Uveal Melanoma: Clinical and Histologic Findings

Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

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