Plaque radiotherapy for juxtapapillary choroidal melanoma. Visual acuity and survival outcome.
OBJECTIVE
To assess the effect of plaque radiotherapy on the visual acuity of patients with juxtapapillary choroidal melanoma and to determine the clinical predictive factors for radiation retinopathy, radiation papillopathy, local tumor recurrence, and distant metastasis.


METHODS
A retrospective review of the medical records of 93 patients with juxtapapillary choroidal melanoma who were treated initially with plaque radiotherapy.


RESULTS
During a mean follow-up of 78 months, radiation retinopathy developed in 81 patients (87%) and radiation papillopathy developed in 48 patients (52%) after a mean interval of 21 and 27 months, respectively. The univariate variables that were significant predictors of radiation retinopathy were history of diabetes mellitus (P = .05) and use of a notched radioactive plaque (P = .04). The factors predictive of radiation papillopathy were age (> 45 years; P = .01), history of diabetes mellitus (P = .05), mushroom-shaped tumor configuration (P = .006), and nasal location of the tumor (P = .04). By using Kaplan-Meier survival curves, we found that the proportion of the 93 patients with radiation retinopathy was 87 (94%) at 5 years and with radiation papillopathy was 53 (57%) at 5 years. By using life-table analysis, we found that the proportion of the 93 patients who experienced a decrement of at least 3 lines of visual acuity was 67 (72%) by 50 to 60 months. Local tumor recurrence was documented in 14 patients (15%) after a mean interval of 41 months. The age of the patient (< 35 years; P = .02) and the superior (P = .004) and inferior (P = .05) locations of the tumor were predictive of local tumor recurrence. Distant metastasis developed in 11 patients (12%) after a mean interval of 44 months. The factors predictive of distant metastasis were a tumor with a basal diameter larger than 6.0 mm (P = .05), the superior location of the tumor (P = .01), and local tumor recurrence (P < .001).


CONCLUSIONS
Based on these observations, plaque radiotherapy remains a potential option vs enucleation for the management of juxtapapillary choroidal melanoma.
Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pa, USA.
P
P
De Potter
C L
CL
Shields
J A
JA
Shields
J R
JR
Cater
L W
LW
Brady
D001918:Brachytherapy / Q000009:adverse effects; D002830:Choroid Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy*; D003037:Cobalt Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D007496:Iridium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009898:Optic Disk / Q000528:radiation effects; D011832:Radiation Injuries / Q000209:etiology; D012160:Retina / Q000528:radiation effects; D012189:Retrospective Studies; D015996:Survival Rate; D014792:Visual Acuity / Q000502:physiology*
D003037:Cobalt Radioisotopes; D007457:Iodine Radioisotopes; D007496:Iridium Radioisotopes