Plaque Radiotherapy for Uveal Melanoma<subtitle>Long-term Visual Outcome in 1106 Consecutive Patients</subtitle>

Abstract

To identify clinical predictive factors for visual outcome in a large series of patients who underwent plaque radiotherapy for uveal melanoma. Design: Clinical factors, including patient data, tumor features, and radiation variables, were analyzed for their impact on visual acuity using Cox proportional hazards regression models. Participants: Patients with uveal melanoma and initial visual acuity of 20/100 or better in the affected eye who were treated with plaque radiotherapy between July 1976 and June 1992. Main Outcome Measures: Two end points were used to evaluate posttreatment visual acuity: (1) final visual acuity (good [20/20-20/100] vs poor [20/200 to no light perception]) and (2) loss of visual acuity (minimal [Ͻ5 lines Snellen visual acuity] vs moderate [Ն5 lines Snellen visual acuity]). Results: Of 1300 consecutive patients with uveal melanoma treated by plaque radiotherapy, 1106 had a visual acuity of 20/100 or better at the time of treatment. In this group, poor visual acuity was found in 34% at 5 years and 68% at 10 years of follow-up. From multivariable analysis, clinical factors that best predicted poor visual acuity were increasing tumor thickness, proximity to foveola of less than 5 mm, notched plaque shape, tumor recurrence, patient age 60 years or older, subretinal fluid, cobalt isotope, anterior tumor margin posterior to equa

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

“…medium-size melanoma, and 64% with large-size melanoma. 9 Similar results were recognized by the Collaborative Ocular Melanoma Study Group in which 6 lines of vision loss were detected in 49% at 3 years, and 43% of those with better than 20/200 at presentation eventually deteriorated to 20/200 or worse at 3 years. 18 Attempts to treat radiation maculopathy have been made using focal laser photocoagulation of leaking macular vessels or nonperfused areas, 19 sector laser photocoagulation to site of radiation, 16,17 oral, subtenon's, or intravitreous corticosteroids, 20,21 and intravitreous injection of antivascular endothelial growth factor.…”

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

“…medium-size melanoma, and 64% with large-size melanoma. 9 Similar results were recognized by the Collaborative Ocular Melanoma Study Group in which 6 lines of vision loss were detected in 49% at 3 years, and 43% of those with better than 20/200 at presentation eventually deteriorated to 20/200 or worse at 3 years. 18 Attempts to treat radiation maculopathy have been made using focal laser photocoagulation of leaking macular vessels or nonperfused areas, 19 sector laser photocoagulation to site of radiation, 16,17 oral, subtenon's, or intravitreous corticosteroids, 20,21 and intravitreous injection of antivascular endothelial growth factor.…”

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

“…All patients in our study had thick tumors, however, only 9.5% of enrolled patients reported by Bergman et al [14] had a tumor thickness more than 7 mm. The importance of tumor thickness on ultimate final visual acuity after brachytherapy has been emphasized in multiple reports [38,39]. Although the comparison of our results and other published outcomes regarding the VA is complicated because of differences in patient demographics, tumor characteristics, and radiation parameters, the percentage of our patients with a final vision of 20/200 or less is comparable to those of Shields et al [26] and Kaiserman et al [15].…”

Reply to Correa et al. Comment on “Rivas et al. Unexpectedly Low Rate of Metastasis and Death Among Patients Treated for Uveal Melanoma with Brachytherapy, Vitrectomy, and Silicone Oil. Cancers 2025, 17, 2683”

“…Patients were then monitored in an independent and consistent fashion by a single melanoma-specialized medical oncologist at a separate location. The median follow-up of patients reported was approximately four years, which is comparable to other studies in the field [ 3 , 4 , 5 ]. Even with these constraints, we believe it is valuable to document the outcomes of these patients.…”

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

“…medium-size melanoma, and 64% with large-size melanoma. 9 Similar results were recognized by the Collaborative Ocular Melanoma Study Group in which 6 lines of vision loss were detected in 49% at 3 years, and 43% of those with better than 20/200 at presentation eventually deteriorated to 20/200 or worse at 3 years. 18 Attempts to treat radiation maculopathy have been made using focal laser photocoagulation of leaking macular vessels or nonperfused areas, 19 sector laser photocoagulation to site of radiation, 16,17 oral, subtenon's, or intravitreous corticosteroids, 20,21 and intravitreous injection of antivascular endothelial growth factor.…”

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

“…All patients in our study had thick tumors, however, only 9.5% of enrolled patients reported by Bergman et al [14] had a tumor thickness more than 7 mm. The importance of tumor thickness on ultimate final visual acuity after brachytherapy has been emphasized in multiple reports [38,39]. Although the comparison of our results and other published outcomes regarding the VA is complicated because of differences in patient demographics, tumor characteristics, and radiation parameters, the percentage of our patients with a final vision of 20/200 or less is comparable to those of Shields et al [26] and Kaiserman et al [15].…”

Reply to Correa et al. Comment on “Rivas et al. Unexpectedly Low Rate of Metastasis and Death Among Patients Treated for Uveal Melanoma with Brachytherapy, Vitrectomy, and Silicone Oil. Cancers 2025, 17, 2683”

“…Patients were then monitored in an independent and consistent fashion by a single melanoma-specialized medical oncologist at a separate location. The median follow-up of patients reported was approximately four years, which is comparable to other studies in the field [ 3 , 4 , 5 ]. Even with these constraints, we believe it is valuable to document the outcomes of these patients.…”

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

“…medium-size melanoma, and 64% with large-size melanoma. 9 Similar results were recognized by the Collaborative Ocular Melanoma Study Group in which 6 lines of vision loss were detected in 49% at 3 years, and 43% of those with better than 20/200 at presentation eventually deteriorated to 20/200 or worse at 3 years. 18 Attempts to treat radiation maculopathy have been made using focal laser photocoagulation of leaking macular vessels or nonperfused areas, 19 sector laser photocoagulation to site of radiation, 16,17 oral, subtenon's, or intravitreous corticosteroids, 20,21 and intravitreous injection of antivascular endothelial growth factor.…”

Ruthenium-106 brachytherapy for thick uveal melanoma: reappraisal of apex and base dose radiation and dose rate

“…All patients in our study had thick tumors, however, only 9.5% of enrolled patients reported by Bergman et al [14] had a tumor thickness more than 7 mm. The importance of tumor thickness on ultimate final visual acuity after brachytherapy has been emphasized in multiple reports [38,39]. Although the comparison of our results and other published outcomes regarding the VA is complicated because of differences in patient demographics, tumor characteristics, and radiation parameters, the percentage of our patients with a final vision of 20/200 or less is comparable to those of Shields et al [26] and Kaiserman et al [15].…”

Reply to Correa et al. Comment on “Rivas et al. Unexpectedly Low Rate of Metastasis and Death Among Patients Treated for Uveal Melanoma with Brachytherapy, Vitrectomy, and Silicone Oil. Cancers 2025, 17, 2683”

“…Patients were then monitored in an independent and consistent fashion by a single melanoma-specialized medical oncologist at a separate location. The median follow-up of patients reported was approximately four years, which is comparable to other studies in the field [ 3 , 4 , 5 ]. Even with these constraints, we believe it is valuable to document the outcomes of these patients.…”