Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: tumor control and treatment complications in 270 consecutive patients.

Abstract

OBJECTIVE:

To evaluate tumor control and treatment complications following plaque radiotherapy combined with transpupillary thermotherapy for choroidal melanoma.

DESIGN:

Prospective noncomparative interventional case series.

INTERVENTION:

All patients received treatment for choroidal melanoma using plaque radiotherapy followed by 3 sessions of transpupillary thermotherapy provided at plaque removal and at 4-month intervals.

PARTICIPANTS:

Two hundred seventy patients with newly diagnosed choroidal melanoma.

MAIN OUTCOME MEASURES:

The 2 main outcome measures included local tumor recurrence and treatment-related complications. The clinical data regarding patient features, tumor features, radiotherapy and thermotherapy parameters were analyzed for their effect on the 2 main outcomes using Cox proportional hazards regression models.

RESULTS:

Prior to treatment, the median base of the tumor was 11 mm (range, 4-21 mm) and the median thickness was 4 mm (range, 2-9 mm). Most tumors were located in the posterior pole with a median proximity of 2 mm to the foveola and 2 mm to the optic disc. The median radiotherapy dose to the tumor apex was 9000 rad. Transpupillary thermotherapy was applied in 3 sessions at 4-month intervals for a median of 700 mW. The tumor decreased in thickness to a median of 2.3 mm by 1 year and 2.1 mm by 2 years' follow-up with stable findings thereafter. Using Kaplan-Meier estimates, tumor recurrence was 2% at 2 years and 3% at 5 years. Risk factors for tumor recurrence included macular location of the tumor epicenter (P =.03), diffuse tumor configuration (P =.005), and tumor margin extending underneath the foveola (P =.001). Using Kaplan-Meier estimates, treatment-related complications at 5 years included maculopathy in 18% of the participants, papillopathy in 38%, macular retinal vascular obstruction in 18%, vitreous hemorrhage in 18%, rhegmatogenous retinal detachment in 2%, cataract in 6%, and neovascular glaucoma in 7%. Enucleation for radiation complications was necessary in 3 cases (1%).

CONCLUSION:

Plaque radiotherapy combined with transpupillary thermotherapy provides excellent local tumor control with only 3% recurrence at 5 years' follow-up.

• Authors: Carol L Shields, Jacqueline Cater, Jerry A Shields, Aning Chao, Hatem Krema, Miguel Materin, Luther W Brady
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 120 Issue 7 Pg. 933-40 (Jul 2002) ISSN: 0003-9950 [Print] United States
• PMID: 12096964 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Iodine Radioisotopes

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Brachytherapy (adverse effects, methods)
• Choroid Neoplasms (pathology, radiotherapy)
• Combined Modality Therapy
• Female
• Humans
• Hyperthermia, Induced (adverse effects, methods)
• Iodine Radioisotopes (adverse effects, therapeutic use)
• Male
• Melanoma (pathology, radiotherapy)
• Middle Aged
• Neoplasm Recurrence, Local
• Prospective Studies
• Pupil
• Treatment Outcome