Mortality after deferral of treatment or no treatment for choroidal melanoma

Abstract

Purpose:To report mortality of patients who were eligible for enrollment in the Collaborative Ocular Melanoma Study (COMS) clinical trials of medium-sized choroidal melanoma or large-sized choroidal melanoma but chose to defer treatment or receive no melanoma treatment.Design:Prospective nonrandomized multicenter cohort study as an adjunct to COMS randomized clinical trials.Methods:Patient follow-up procedures included examinations, correspondence, telephone contacts, and National Death Index searches. Primary outcome was patient death measured by all-cause mortality. Secondary outcomes were melanoma treatment and melanoma metastasis.Results:Of 77 patients eligible for COMS clinical trials who chose to defer or receive no melanoma treatment, 61 were appropriate candidates and 45 (74%) enrolled in the natural history study (NHS). In all, 42 patients (42 eyes) had medium melanoma, and the median follow-up was 5.3 years (range, 4–10.7 years). In all, 22 patients (52%) had subsequent melanoma treatment, and 20 (48%) had no melanoma treatment. For the 42 patients, Kaplan–Meier estimate of 5-year mortality was approximately 30% [95% confidence interval (CI), 18%–47%]. For COMS medium melanoma trial, 5-year mortality was 18% (95% CI, 16%–20%), not statistically significantly different from the NHS patients. After adjusting for differences in age and longest basal diameter, the 5-year risk of death for NHS patients versus COMS trial patients was 1.54 (95% CI, 0.93–2.56). Three patients had large melanoma. Melanoma metastasis was confirmed or suspected in 8 (42%) of 19 deaths.Conclusion:Greater mortality and higher risk of death for NHS patients are probative but not conclusive evidence of a beneficial, life-extending effect of medium melanoma treatment.

Robotic radiosurgery for the treatment of medium and large uveal melanoma

“…Our 5-year disease-specific mortality was comparable to other studies [8,20,22]. Local effective therapy seems important as delay or refusal of treatment is associated with an increased incidence of metastatic disease and/or death compared with mortality rates of patients who received prompt treatment [30,31]. However, 5-year metastatic disease rates are probably not going to be favorably influenced by any treatment of the primary tumor as the interval can be long (up to 30 years) before micrometastases become clinically evident [32].…”

Robotic radiosurgery for the treatment of medium and large uveal melanoma

“…Our 5-year disease-specific mortality was comparable to other studies [8,20,22]. Local effective therapy seems important as delay or refusal of treatment is associated with an increased incidence of metastatic disease and/or death compared with mortality rates of patients who received prompt treatment [30,31]. However, 5-year metastatic disease rates are probably not going to be favorably influenced by any treatment of the primary tumor as the interval can be long (up to 30 years) before micrometastases become clinically evident [32].…”

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

“…Thus, which procedure is chosen for local control has only a marginal effect on survival outcomes. The COMS natural history study also confirmed this theory [ 21 ]. As such, EPBT may be a preferable treatment for these tumors since it allows for globe and vision preservation.…”

“…confirmed this theory [21]. As such, EPBT may be a preferable treatment for these tumors since it allows for globe and vision preservation.…”

No differences in the long-term prognosis of iris and choroidal melanomas when adjusting for tumor thickness and diameter

“…This may be a utopia for choroidal and ciliary body melanomas that are often asymptomatic until they have become medium-sized or even large but is perfectly illustrated by iris melanomas: They are treated when they are small, and metastatic rates are low. This conclusion may be supported by previous indications of increased mortality among patients who chose to defer or receive no treatment, whereas it is contradicted by other studies that have found no increased mortality when treatment is delayed [34,35].…”

Robotic radiosurgery for the treatment of medium and large uveal melanoma

“…Our 5-year disease-specific mortality was comparable to other studies [8,20,22]. Local effective therapy seems important as delay or refusal of treatment is associated with an increased incidence of metastatic disease and/or death compared with mortality rates of patients who received prompt treatment [30,31]. However, 5-year metastatic disease rates are probably not going to be favorably influenced by any treatment of the primary tumor as the interval can be long (up to 30 years) before micrometastases become clinically evident [32].…”

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

“…Thus, which procedure is chosen for local control has only a marginal effect on survival outcomes. The COMS natural history study also confirmed this theory [ 21 ]. As such, EPBT may be a preferable treatment for these tumors since it allows for globe and vision preservation.…”

“…confirmed this theory [21]. As such, EPBT may be a preferable treatment for these tumors since it allows for globe and vision preservation.…”

No differences in the long-term prognosis of iris and choroidal melanomas when adjusting for tumor thickness and diameter

“…This may be a utopia for choroidal and ciliary body melanomas that are often asymptomatic until they have become medium-sized or even large but is perfectly illustrated by iris melanomas: They are treated when they are small, and metastatic rates are low. This conclusion may be supported by previous indications of increased mortality among patients who chose to defer or receive no treatment, whereas it is contradicted by other studies that have found no increased mortality when treatment is delayed [34,35].…”

Robotic radiosurgery for the treatment of medium and large uveal melanoma

“…Our 5-year disease-specific mortality was comparable to other studies [8,20,22]. Local effective therapy seems important as delay or refusal of treatment is associated with an increased incidence of metastatic disease and/or death compared with mortality rates of patients who received prompt treatment [30,31]. However, 5-year metastatic disease rates are probably not going to be favorably influenced by any treatment of the primary tumor as the interval can be long (up to 30 years) before micrometastases become clinically evident [32].…”

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

“…Thus, which procedure is chosen for local control has only a marginal effect on survival outcomes. The COMS natural history study also confirmed this theory [ 21 ]. As such, EPBT may be a preferable treatment for these tumors since it allows for globe and vision preservation.…”

“…confirmed this theory [21]. As such, EPBT may be a preferable treatment for these tumors since it allows for globe and vision preservation.…”

No differences in the long-term prognosis of iris and choroidal melanomas when adjusting for tumor thickness and diameter

“…This may be a utopia for choroidal and ciliary body melanomas that are often asymptomatic until they have become medium-sized or even large but is perfectly illustrated by iris melanomas: They are treated when they are small, and metastatic rates are low. This conclusion may be supported by previous indications of increased mortality among patients who chose to defer or receive no treatment, whereas it is contradicted by other studies that have found no increased mortality when treatment is delayed [34,35].…”