Post-brachytherapy initial tumour regression rate correlates with metastatic spread in posterior uveal melanoma.
OBJECTIVE
To confirm the prognostic value of post-brachytherapy initial tumour regression rate in posterior uveal melanoma.


METHODS
A prospective, comparative, observational cohort study was carried out on 147 eyes (147 patients) with choroidal melanoma (mean age 61 years) treated with Ru-106 brachytherapy.


METHODS
Patients were followed clinically and ultrasonically every 6.7 (SD 0.3) months (1001 examinations). On average each patient was examined 5.8 times (mean follow up 9.6 (3.7) years). The echographic parameters included tumour base size, height, internal reflectivity, regularity, vascularity, and extrascleral extension. The clinical follow up included ocular examination and periodic metastatic screening (liver function tests and liver imaging). Main outcome measures were risk of liver metastasis in correlation with the post-brachytherapy initial tumour regression rate.


RESULTS
At brachytherapy the mean tumour height was 5.2 mm (range 2.2-11.8 mm). After brachytherapy 142 tumours (96.6%) responded by a decrease in height. The initial height regression rate was 6.1% (0.8%) per month in patients who later developed metastasis v 4.3% (0.4%) per month in those who did not. Tumours higher than 6 mm, tumours with an internal reflectivity smaller than 50%, and tumours with an initial rate of height regression larger than 0.7 mm/month (10% per month) had higher 5 year melanoma related mortality. Kaplan-Meier survival analysis and the multivariate Cox proportional hazards model showed a significant role for tumour height and initial tumour regression rate on patients' survival.


CONCLUSIONS
This study confirms that post-brachytherapy initial tumour regression rate has a prognostic value.
Kaiserman
I
I
Department of Ophthalmology, Hadassah University Hospital, POB 12000, IL-91120 Jerusalem, Israel. Igork@cc.huji.ac.il
Anteby
I
I
Chowers
I
I
Blumenthal
E Z
EZ
Kliers
I
I
Pe'er
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012074:Remission Induction; D016019:Survival Analysis; D014604:Uveal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*