title: Risk factors associated with secondary enucleation after fractionated stereotactic radiotherapy in uveal melanoma.
abstract: OBJECTIVE
  To evaluate risk factors for secondary enucleation after fractionated stereotactic radiotherapy (fSRT) in uveal melanoma.
  
  
  METHODS
  In this retrospective study, clinical data of 118 consecutive patients who had initially been treated with fSRT between 1999 and 2009 were collected and analysed. The patients who had undergone secondary enucleation were identified and examined for clinical, histopathological and cytogenetical (fluorescence in situ hybridization determined) data. Also, the reasons for secondary enucleation, such as treatment failure (progressive tumour growth or tumour recurrence) or complications following fSRT (painful blind eye), were recorded and examined.
  
  
  RESULTS
  The secondary enucleation rate was 16% after a median follow-up of 4.7 years, with 5% due to treatment failure and 11% due to complications. In the univariate analysis, large tumour diameter (p = 0.019) and large tumour height (p = 0.001) were associated with secondary enucleation, tumour involvement of the optic disc showed borderline significance (p = 0.068). Cox regression multivariate analysis displayed large tumour height as independent prognostic factor (HR 1.42, 95% CI 1.12-1.81, p = 0.004). Following secondary enucleation, mitotic figures were present in five of 18 tumours, and gain of chromosome 8q was also present in five tumours. Within the subgroup of patients who required secondary enucleation due to failed tumour control by fSRT (N = 6), mitotic figures were present in four of six tumours while gain of 8q was present in three of six tumours.
  
  
  CONCLUSIONS
  Secondary enucleation after previous fSRT was associated with large tumour height. High mitotic counts and gain of chromosome 8q were frequently found in secondary enucleations and possibly indicate a more aggressive or radiation-resistant tumour.
authors: Ocular Oncology, Rotterdam Eye Hospital, Rotterdam, The Netherlands.
authors: Thomas
authors: T
authors: van den Bosch
authors: Department of Clinical Genetics, Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Jolanda
authors: J
authors: Vaarwater
authors: Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Rob
authors: R
authors: Verdijk
authors: Department of Radiotherapy, Deventer Hospital, Deventer, The Netherlands.
authors: Karin
authors: K
authors: Muller
authors: Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Emine
authors: E
authors: Kiliç
authors: Ocular Oncology, Rotterdam Eye Hospital, Rotterdam, The Netherlands.|Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland.
authors: Dion
authors: D
authors: Paridaens
authors: Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Annelies
authors: A
authors: de Klein
authors: Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Nicole
authors: N
authors: Naus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002898:Chromosomes, Human, Pair 8 / Q000235:genetics; D019583:Dose Fractionation, Radiation; D015353:Eye Enucleation / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008545:Melanoma / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D008940:Mitotic Index; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016634:Radiosurgery; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D014604:Uveal Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D000098943:Uveal Melanoma
keywords: enucleation; genetics; radiotherapy; uveal melanoma