title: Intravitreal bevacizumab combined with plaque brachytherapy reduces melanoma tumor volume and enhances resolution of exudative detachment.
abstract: BACKGROUND
  The purpose of this study was to evaluate intravitreal bevacizumab as an adjuvant treatment to plaque brachytherapy in the treatment of choroidal melanoma.
  
  
  METHODS
  This was a retrospective, consecutive study of 124 patients treated from 2007 to 2009 for choroidal melanoma with plaque brachytherapy. Patients were treated with I-125 plaque brachytherapy with 2 mm margins and 85 Gy to the tumor apex. Consecutive patients were injected intravitreally with 2.5 mg/0.1 mL bevacizumab at a site away from the primary tumor and immediately following plaque removal. Choroidal melanomas were observed using indirect ophthalmoscopy, wide-angle photography, and ultrasound. The main outcome measures were tumor volume, resolution of exudative retinal detachment, and visual acuity.
  
  
  RESULTS
  One hundred and twenty-four patients met our inclusion criteria and were included in the analysis. The mean patient age was 65.7 years, and the mean apical tumor height was 4.0 ± 2.7 mm and basal diameter was 12.7 ± 3.0 mm. Mean follow-up was 24 months. Prior to treatment, 100% of tumors had exudative retinal detachment, and pretreatment visual acuity was 20/55 (median 20/40). Tumor control was 100%, metastasis was 0% at last follow-up, and 89.8% had complete resolution of exudative retinal detachment, with a mean time to resolution of 3.36 months. At one month, 43% had complete resolution of exudative retinal detachment, which increased to 73% at 4 months. Visual acuity was 20/62 (median 20/40) at 4 months, with stabilization to 20/57 (median 20/40) at 8 months, 20/56 (median 20/30) at 12 months, and 20/68 (median 20/50) at 24 months. Tumor volume following combined therapy was shown to be reduced by 22.2% at 3 months, 28.9% at 6 months, 39.3% at 12 months, and 52.2% at 24 months (all P < 0.001). All patients tolerated the procedure well without systemic side effects.
  
  
  CONCLUSIONS
  Intravitreal bevacizumab may be used as an adjuvant agent following plaque brachytherapy. Treated choroidal melanomas show reduction in tumor volume as well as resolution of exudative retinal detachments.
authors: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
authors: Samuel K
authors: SK
authors: Houston
authors: Nisha V
authors: NV
authors: Shah
authors: Christina
authors: C
authors: Decatur
authors: Marcela
authors: M
authors: Lonngi
authors: William
authors: W
authors: Feuer
authors: Arnold M
authors: AM
authors: Markoe
authors: Timothy G
authors: TG
authors: Murray
keywords: Avastin (bevacizumab); brachytherapy; choroidal melanoma; retinal detachment
references: Ophthalmology. 1999 Aug;106(8):1579-87
references: 10442907
references: Br J Ophthalmol. 1990 Jun;74(6):359-62
references: 2378844
references: Arch Ophthalmol. 2002 Nov;120(11):1463-9
references: 12427058
references: Br J Ophthalmol. 2002 Apr;86(4):448-52
references: 11914216
references: Arch Ophthalmol. 2006 Dec;124(12):1684-93
references: 17159027
references: Ophthalmology. 2011 Feb;118(2):402-7
references: 20813410
references: Ophthalmology. 1993 Oct;100(10):1555-9; discussion 1560
references: 8414415
references: Eur J Ophthalmol. 2011 Nov-Dec;21(6):796-801
references: 21445839
references: Arch Ophthalmol. 2002 Jul;120(7):933-40
references: 12096964
references: Br J Ophthalmol. 2003 Nov;87(11):1370-3
references: 14609837
references: Ophthalmology. 2002 Dec;109(12):2197-206
references: 12466159
references: Retina. 2008 Jul-Aug;28(7):987-95
references: 18698302
references: Ophthalmology. 1989 Mar;96(3):382-8
references: 2710530
references: Retina. 1996;16(2):129-34
references: 8724957
references: Am J Ophthalmol. 1999 May;127(5):579-89
references: 10334352
references: Graefes Arch Clin Exp Ophthalmol. 2006 Dec;244(12):1575-80
references: 16738857
references: Invest Ophthalmol Vis Sci. 2009 Dec;50(12):5537-43
references: 19578014
references: Br J Ophthalmol. 2008 Aug;92(8):1040-5
references: 18653597
references: Am J Ophthalmol. 2003 Jun;135(6):898-9
references: 12788137
references: Invest Ophthalmol Vis Sci. 2001 Aug;42(9):2085-93
references: 11481276
references: Arch Ophthalmol. 2006 Oct;124(10):1428-34
references: 17030710
references: Am J Ophthalmol. 2011 Feb;151(2):323-8.e2
references: 21168817
references: Eur J Ophthalmol. 2010 Jan-Feb;20(1):194-200
references: 19882527
references: Ophthalmology. 1991 Jun;98(6):984-8
references: 1866154
references: Arch Ophthalmol. 2001 Jul;119(7):969-82
references: 11448319
references: Int J Radiat Oncol Biol Phys. 1998 Jun 1;41(3):701-6
references: 9635722
references: Med Phys. 1995 Feb;22(2):209-34
references: 7565352