title: Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26.
abstract: OBJECTIVE
  To describe the time between treatment for choroidal melanoma and first diagnosis of metastatic disease, sites of metastasis, treatments for metastasis, and time between diagnosis of metastasis and death.
  
  
  METHODS
  Prospective, longitudinal follow-up of patients diagnosed with choroidal melanoma who were enrolled in 2 randomized trials conducted by the Collaborative Ocular Melanoma Study Group.
  
  
  METHODS
  Systemic and laboratory evaluations were performed during follow-up according to a standard protocol for 2320 patients enrolled in the Collaborative Ocular Melanoma Study trials without evidence of melanoma metastasis or other primary cancer at baseline.
  
  
  RESULTS
  Seven hundred thirty-nine patients were diagnosed with at least 1 site of metastasis during follow-up after treatment for choroidal melanoma. Five- and 10-year cumulative metastasis rates were 25% (95% confidence interval, 23%-27%) and 34% (95% confidence interval, 32%-37%), respectively. Liver was the most common site (89%). The death rate following the report of melanoma metastasis was 80% at 1 year (95% confidence interval, 77%-83%) and 92% at 2 years (95% confidence interval, 89%-94%). Overall survival after metastasis did not vary by baseline size of primary tumor nor treatment for metastasis (when known). Long-term survival after diagnosis of metastasis was uncommon; only 8 patients survived 5 or more years.
  
  
  CONCLUSIONS
  Metastasis rate increased significantly with increasing primary tumor dimensions at time of patient enrollment. Prognosis after metastatic disease remains poor. Effective methods are needed to prevent, diagnose, and treat metastasis from choroidal melanoma.
authors.affiliation: Coordinating Center, Wilmer Clinical Trials and Biometry, 550 N Broadway, Ninth Floor, Baltimore, MD 21205, USA. mdiener@jhsph.edu
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Reynolds
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Agugliaro
authors.forename: Robert
authors.initials: R
authors.lastname: Caldwell
authors.forename: Kristi
authors.initials: K
authors.lastname: Cumming
authors.forename: John D
authors.initials: JD
authors.lastname: Earle
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Hawkins
authors.forename: James A
authors.initials: JA
authors.lastname: Hayman
authors.forename: Ishmael
authors.initials: I
authors.lastname: Jaiyesimi
authors.forename: Lee M
authors.initials: LM
authors.lastname: Jampol
authors.forename: John M
authors.initials: JM
authors.lastname: Kirkwood
authors.forename: Wui-Jin
authors.initials: WJ
authors.lastname: Koh
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Robertson
authors.forename: John M
authors.initials: JM
authors.lastname: Shaw
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Straatsma
authors.forename: Jonni
authors.initials: J
authors.lastname: Thoma
mesh_terms: D000368:Aged; D001918:Brachytherapy; D002830:Choroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors
chemical_list: D007457:Iodine Radioisotopes