Impact of uveal melanoma thickness on post-plaque radiotherapy outcomes in the prophylactic anti-vascular endothelial growth factor era in 1131 patients.

Abstract

IMPORTANCE:

The impact of tumour thickness on radiation complications following plaque radiotherapy for uveal melanoma in the anti-vascular endothelial growth factor (VEGF) era remains unknown.

BACKGROUND:

To evaluate treatment outcomes following plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma based on initial tumour thickness.

DESIGN:

This was a retrospective, interventional case series.

PARTICIPANTS:

Patients with uveal melanoma were included in this study.

METHODS:

A review of medical records was conducted of patients with uveal melanoma treated with plaque radiotherapy and prophylactic intravitreal bevacizumab from 7 July 2000 to 2 November 2018.

MAIN OUTCOMES MEASURES:

Radiation-related outcomes of cystoid macular oedema (CME), radiation maculopathy, papillopathy, retinopathy, iris neovascularization (NVI) and neovascular glaucoma (NVG) were compared based on tumour thickness (small [<3.0 mm] vs medium [3.1-8.0 mm] vs large [>8.0 mm]).

RESULTS:

Of 1131 eyes, 341 (30%) had small, 633 (56%) medium and 157 (14%) large melanoma. Comparison (small vs medium vs large) at 4 years following radiotherapy revealed large melanoma with greater Kaplan-Meier estimated risk of CME (37% vs 37% vs 63%, P < .001), earlier onset of CME (33 vs 26 vs 19 months, P < .001) and greater development of NVI (<1% vs 2% vs 13%, P < .001) and NVG (1% vs 2% vs 12%, P < .001). Radiation-induced maculopathy, papillopathy and retinopathy were not associated with tumour thickness.

CONCLUSIONS AND RELEVANCE:

Compared with small and medium uveal melanoma, large uveal melanoma demonstrated greater 48-month risk for CME, shorter time to CME onset and greater development of NVI and NVG following plaque radiotherapy and prophylactic intravitreal bevacizumab.

• Authors: Xiaolu Yang, Lauren A Dalvin, Mehdi Mazloumi, Michael Chang, Jerry A Shields, Arman Mashayekhi, Carol L Shields
• Journal: Clinical & experimental ophthalmology (Clin Exp Ophthalmol) Vol. 48 Issue 5 Pg. 610-623 (07 2020) ISSN: 1442-9071 [Electronic] Australia
• PMID: 32277560 (Publication Type: Journal Article, Review)
• Copyright: © 2020 Royal Australian and New Zealand College of Ophthalmologists.

Topics

• Brachytherapy (adverse effects)
• Humans
• Melanoma (radiotherapy)
• Retrospective Studies
• Uveal Neoplasms (radiotherapy)
• Visual Acuity