title: Metastatic risk for distinct patterns of postirradiation local recurrence of posterior uveal melanoma.
abstract: OBJECTIVE
  The purpose of the study is to compare the prognostic significance of horizontal/marginal versus vertical/diffuse patterns of postirradiation local recurrence of posterior uveal melanoma.
  
  
  METHODS
  The study design was a nonrandomized, retrospective clinical study. Semiparametric and nonparametric statistical techniques were used.
  
  
  METHODS
  Seven hundred sixty-six posterior uveal melanoma patients were studied.
  
  
  METHODS
  Either iodine-125 plaque or helium ion radiation therapy was performed.
  
  
  METHODS
  Local tumor recurrence and systemic metastasis were measured.
  
  
  RESULTS
  Local tumor recurrence was detected in 66 (8.6%) of 766 irradiated tumors. The 5-year actuarial rate of local recurrence was 10%. The recurrence pattem was horizontal/marginal in 27 patients (41%) and vertical/diffuse in 39 patients (59%). Systemic metastasis was detected in 5 patients (19%) with horizontal/marginal recurrence and in 19 patients (49%) with vertical/diffuse recurrence. After known metastatic risk factors were controlled, the relative risk for metastasis was 2.2 for horizontal/marginal recurrence and 5.1 for vertical/diffuse recurrence (P = 0.05). The actuarial rate of systemic metastasis was 2.9% per year for all patients, 6.3% per year for patients with horizontal/marginal recurrence, and 15.5% per year for patients with vertical/diffuse recurrence.
  
  
  CONCLUSIONS
  Postirradiation local recurrence of posterior uveal melanoma is a risk factor for systemic metastasis. Vertical/diffuse recurrences may be associated more strongly with metastatic disease than horizontal/marginal recurrences.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Harbour
authors.forename: D H
authors.initials: DH
authors.lastname: Char
authors.forename: S
authors.initials: S
authors.lastname: Kroll
authors.forename: J M
authors.initials: JM
authors.lastname: Quivey
authors.forename: J
authors.initials: J
authors.lastname: Castro
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D005260:Female; D006371:Helium / Q000627:therapeutic use*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000556:secondary*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000473:pathology*; D011379:Prognosis; D011867:Radioisotope Teletherapy; D012189:Retrospective Studies; D012307:Risk Factors; D014604:Uveal Neoplasms / Q000209:etiology / Q000473:pathology* / Q000532:radiotherapy
chemical_list: D007457:Iodine Radioisotopes; D006371:Helium