Plaque radiotherapy for choroidal and ciliochoroidal melanomas with limited nodular extrascleral extension.
BACKGROUND
Currently available clinical information regarding management of posterior uveal melanomas complicated by nodular extrascleral extension is inadequate to determine the role, if any, for plaque radiotherapy in such patients.


METHODS
The authors performed a retrospective descriptive study of eight patients with a choroidal or ciliochoroidal melanoma complicated by nodular extrascleral extension who were treated by surgical excision of the extrascleral nodule followed immediately by plaque radiotherapy of the intraocular tumour. The calculated volume of the extrascleral nodule was greater than 1 mm3 but less than 1000 mm3 in all cases, and the intraocular tumour was deemed treatable by plaque radiotherapy in all patients.


RESULTS
Four of the eight patients died during available follow-up, three from metastatic melanoma and one from a second cancer. The median length of follow-up for the four surviving patients was 10.1 years. The actuarial 5-year and 10-year all-cause death rates were 37.5% and 53.1% respectively. One of the eight patients experienced local intraocular tumour relapse following plaque therapy and underwent secondary enucleation. None of the patients experienced orbital tumour recurrence or underwent secondary orbital exenteration.


CONCLUSIONS
Our results coupled with previously published results from another centre suggest that plaque radiotherapy may be an effective local treatment for selected patients with choroidal or ciliochoroidal melanoma complicated by nodular extrascleral extension. The fact that none of the patients in this series or in the previously reported series experienced orbital recurrence following plaque radiotherapy or required secondary orbital exenteration suggests that plaque therapy may be better than enucleation alone in terms of these end points. These results should not be extrapolated, of course, to patients with massive extrascleral tumour extension or a choroidal or ciliochoroidal melanoma too large for plaque radiotherapy.
Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0527, USA. augsbujj@uc.edu
James J
JJ
Augsburger
Susan
S
Schneider
Ashwatha
A
Narayana
John C
JC
Breneman
Bernard S
BS
Aron
William L
WL
Barrett
Nikolaos
N
Trichopoulos
D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D002830:Choroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002924:Ciliary Body / Q000473:pathology / Q000528:radiation effects*; D005134:Eye Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012590:Sclera / Q000473:pathology; D015422:Scleral Diseases / Q000401:mortality / Q000532:radiotherapy*; D015996:Survival Rate; D014604:Uveal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy