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

Pham, Chau; Couch, Steven M.; Harocopos, George J.

doi:10.1159/000477302

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…In contrast, 11 of 15 RISN cases (73%) required surgical therapy with scleral patch and/or conjunctival ap in the UM cohort threated with 198 Au brachytherapy 10 . In a large institutional series with 301 consecutive patients treated with 125 I brachytherapy, 6 (2%) patients were enucleated due to RISN 14 . In our study, about the half of 115 patients underwent surgery due to RISN, whereas the occurrence of RISN in rst 15 months after brachytherapy was signi cantly associated with the therapy indication.…”

Section: Risn Treatment: Rate and Prognostic Factorsmentioning

confidence: 99%

Prognostic factors for surgical treatment of radiation-induced scleral necrosis after brachytherapy for uveal melanoma

Jabbarli

Biewald²,

Guberina³

et al. 2022

Preprint

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Objectives: Radiation-induced scleral necrosis (RISN) is a rare complication of brachytherapy for uveal melanoma, and may require surgical treatment in selected cases. We aimed to identify the prognostic factors for RISN treatment. Design: Retrospective, single-center, observational case series Methods: All patients with brachytherapy for uveal melanoma treated at our institution between 01/1999 and 12/2016 who developed RISN were followed until 02/2021. Various parameters were evaluated through univariable and multivariable Cox regression analysis. The surgical intervention due to RISN was the principal outcome event of this study. Results: Of 115 patients in the final cohort, 51 individuals (44.3%) underwent RISN treatment (conjunctival revision [n = 2], patching [n = 46] or enucleation [n = 3]) at median 1.80 months after RISN occurrence. Significant RISN characteristics were summarized into a novel RISN severity scale – Grade I: largest diameter ≤ 5mm and no progression; Grade II: largest diameter > 5mm or any progression during the follow-up; Grade III: presence of uveal prolapse; and Grade IV: leakage through open eyewall perforation. In the multivariable analysis, the RISN severity scale (aHR = 2.37 per grade increase, p = 0.005) and the time between brachytherapy and RISN occurrence (< 15 months, aHR = 6.33, p < 0.0001) were independently associated with the study endpoint. The RISN severity scale showed high diagnostic accuracy for prediction of RISN treatment (AUC = 0.869). Conclusions: In our series, about the half of RISN cases underwent surgical treatment. The presented novel severity scale for RISN might become a helpful tool for clinical management of individuals with RISN. We recommend external validation of the diagnostic accuracy of the presented scale.

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Section: Risn Treatment: Rate and Prognostic Factorsmentioning

confidence: 99%

Prognostic factors for surgical treatment of radiation-induced scleral necrosis after brachytherapy for uveal melanoma

Jabbarli

Biewald²,

Guberina³

et al. 2022

Preprint

View full text Add to dashboard Cite

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Extrascleral extension of choroidal melanoma after iodine-125 brachytherapy treatment: a case series

Mustak

Cohen

et al. 2022

Eye

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BACKGROUND/OBJECTIVES: The purpose of this study is to report cases of choroidal melanoma that developed extrascleral tumour recurrence after treatment with iodine-125 brachytherapy. SUBJECTS/METHODS: In this single-institution retrospective observational case series, all instances of biopsy-confirmed orbital melanoma after known intraocular melanoma were reviewed. Tumour characteristics, clinical course, time to recurrence, cytogenetics of initial tumour and recurrence, and presence of intraocular recurrence were documented. RESULTS: Five cases of orbital melanoma following treatment with plaque radiotherapy are described. Tumour staging was Ia (1), IIa (2), and IIb (2). The primary lesion in four of the five appeared to have undergone complete regression for an average of 2 years, with the orbital melanoma developing after this interval. Recurrence of the intraocular tumour was seen in conjunction with an extrascleral component in two cases. Four cases ultimately underwent enucleation or exenteration; three had evidence of direct extension of tumour through the sclera. Four cases in this series had molecular characteristics associated with high metastatic risk (three patients with monosomy 3, one with BAP1 mutation). CONCLUSIONS: High-risk tumour biology may predispose to late appearance of extrascleral melanoma despite optimal treatment and adequate control of the intraocular tumour. Extended follow-up with detailed orbital examination and imaging is recommended for this population.

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Prognostic factors for surgical treatment of radiation-induced scleral necrosis after brachytherapy for uveal melanoma

Jabbarli,

Biewald,

Guberina

et al. 2024

European Journal of Ophthalmology

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Purpose Radiation-induced scleral necrosis (RISN) is a less frequent complication of brachytherapy for uveal melanoma, and may require surgical treatment in selected cases. We aimed to identify the prognostic factors for RISN treatment. Methods All patients with brachytherapy for uveal melanoma treated at our institution between 01/1999 and 12/2016 who developed RISN were followed until 02/2021. Various parameters were evaluated through univariable and multivariable Cox regression analysis. The surgical intervention due to RISN was the principal outcome event of this study. Results Of 115 patients in the final cohort, 51 individuals (44%) underwent RISN treatment (conjunctival revision [n = 2], patching [n = 46] or enucleation [n = 3]) at median 1.80 months after RISN occurrence. Significant RISN characteristics were summarized into a novel RISN severity scale – Grade I: largest diameter ≤ 5 mm and no progression; Grade II: largest diameter > 5 mm or any progression during the follow-up; Grade III: presence of uveal prolapse; and Grade IV: leakage through open eyewall perforation. In the multivariable analysis, the RISN severity scale (aHR = 2.37 per grade increase, p = 0.01) and the time between brachytherapy and RISN occurrence (<15 months, aHR = 6.33, p < 0.0001) were independently associated with the study endpoint. The RISN severity scale showed high diagnostic accuracy for prediction of RISN treatment (AUC = 0.869). Conclusions In our series, about the half of RISN cases underwent surgical treatment. The presented novel severity scale for RISN might become a helpful tool for clinical management of individuals with RISN. We recommend external validation of the diagnostic accuracy of the presented scale.

show abstract

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

Cited by 3 publications

References 23 publications

Prognostic factors for surgical treatment of radiation-induced scleral necrosis after brachytherapy for uveal melanoma

Prognostic factors for surgical treatment of radiation-induced scleral necrosis after brachytherapy for uveal melanoma

Extrascleral extension of choroidal melanoma after iodine-125 brachytherapy treatment: a case series

Prognostic factors for surgical treatment of radiation-induced scleral necrosis after brachytherapy for uveal melanoma

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