Metastatic risk for distinct patterns of postirradiation local recurrence of posterior uveal melanoma.
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.
Harbour
J W
JW
Department of Ophthalmology, University of California, San Francisco, USA.
Char
D H
DH
Kroll
S
S
Quivey
J M
JM
Castro
J
J
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
D007457:Iodine Radioisotopes; D006371:Helium