title: Uveal melanoma treated with iodine-125 episcleral plaque: an analysis of dose on disease control and visual outcomes.
abstract: OBJECTIVE
  To investigate, in the treatment of uveal melanomas, how tumor control, radiation toxicity, and visual outcomes are affected by the radiation dose at the tumor apex.
  
  
  METHODS
  A retrospective review was performed to evaluate patients treated for uveal melanoma with (125)I plaques between 1988 and 2010. Radiation dose is reported as dose to tumor apex and dose to 5 mm. Primary endpoints included time to local failure, distant failure, and death. Secondary endpoints included eye preservation, visual acuity, and radiation-related complications. Univariate and multivariate analyses were performed to determine associations between radiation dose and the endpoint variables.
  
  
  RESULTS
  One hundred ninety patients with sufficient data to evaluate the endpoints were included. The 5-year local control rate was 91%. The 5-year distant metastases rate was 10%. The 5-year overall survival rate was 84%. There were no differences in outcome (local control, distant metastases, overall survival) when dose was stratified by apex dose quartile (<69 Gy, 69-81 Gy, 81-89 Gy, >89 Gy). However, increasing apex dose and dose to 5-mm depth were correlated with greater visual acuity loss (P=.02, P=.0006), worse final visual acuity (P=.02, P<.0001), and radiation complications (P<.0001, P=.0009). In addition, enucleation rates were worse with increasing quartiles of dose to 5 mm (P=.0001).
  
  
  CONCLUSIONS
  Doses at least as low as 69 Gy prescribed to the tumor apex achieve rates of local control, distant metastasis-free survival, and overall survival that are similar to radiation doses of 85 Gy to the tumor apex, but with improved visual outcomes.
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Perez
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Mettu
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Lejla
authors.initials: L
authors.lastname: Vajzovic
authors.affiliation: Austin Cancer Centers, Austin, Texas.
authors.forename: Douglas
authors.initials: D
authors.lastname: Rivera
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Ali
authors.initials: A
authors.lastname: Alkaissi
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Steffey
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Jing
authors.initials: J
authors.lastname: Cai
authors.affiliation: Department of Biostatistics and Informatics, Duke University, Durham, North Carolina.
authors.forename: Sandra
authors.initials: S
authors.lastname: Stinnett
authors.affiliation: Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Dutton
authors.affiliation: Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Buckley
authors.affiliation: Department of Radiation Oncology, New York Medical College, Valhalla, New York.
authors.forename: Edward
authors.initials: E
authors.lastname: Halperin
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Ophthalmology, Duke University, Durham, North Carolina.
authors.forename: Prithvi
authors.initials: P
authors.lastname: Mruthyunjaya
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina; Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina. Electronic address: david.kirsch@duke.edu.
authors.forename: David G
authors.initials: DG
authors.lastname: Kirsch
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002830:Choroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D002924:Ciliary Body; D018572:Disease-Free Survival; D015353:Eye Enucleation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D016014:Linear Models; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012590:Sclera; D017211:Treatment Failure; D047368:Tumor Burden; D014604:Uveal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D014792:Visual Acuity / Q000528:radiation effects*; D000098943:Uveal Melanoma
chemical_list: D007457:Iodine Radioisotopes