title: Choroidal melanoma treated with stereotactic fractionated radiotherapy and prophylactic intravitreal bevacizumab: The Dunedin Hospital experience.
abstract: BACKGROUND
  Choroidal melanoma (CM) is the most common primary ocular malignancy in adults. This study reviewed the Dunedin Hospital (DH) experience in the treatment of CM with stereotactic fractionated radiotherapy (SRT) and the outcome of prophylactic use of intravitreal injection bevacizumab (PIB) in preventing radiation retinopathy (RR).
  
  
  METHODS
  A retrospective study was conducted of patients at DH who underwent SRT for CM with and without PIB from 1 January 2001 to 31 January 2012. In DH, some patients who had SRT following the introduction of intravitreal bevacizumab in December 2006 were also treated with PIB with the expectation that this might reduce the risk of developing RR, although the evidence of its effectiveness in this respect is not clear. The primary outcome measure was local progression as monitored with regular ultrasound. Secondary outcome measures were metastatic progression incidence, enucleation incidence, no functional vision incidence, overall survival, disease-specific mortality, incidence of RR, and radiotherapy to clinical diagnosis of RR time.
  
  
  RESULTS
  Twenty-seven patients who were followed up at DH were reviewed after a mean follow-up of 5.1 years (range 0.4-12.6). Fourteen patients received PIB. The local progression, metastatic progression and enucleation rate were 4%, 8% and 11%, respectively. The no functional vision (hand movements or less) rate was 62%. Overall survival was 63%, but only three (11%) deaths were due to metastatic choroidal melanoma. Incidence of RR was 57% and 54% for those that received PIB and those who did not, respectively. PIB did not reduce the rate of RR (P = 1.00).
  
  
  CONCLUSIONS
  This study reaffirmed that SRT achieves very good local control and eye retention rates. PIB did not appear to reduce the radiation retinopathy rate in this study, and more studies are required especially Phase II and III trials to determine PIB efficacy in preventing RR.
authors.affiliation: Dunedin Hospital, Dunedin, New Zealand.
authors.forename: Nur Azri Bin
authors.initials: NA
authors.lastname: Haji Mohd Yasin
authors.affiliation: University of Otago Dunedin School of Medicine, Dunedin, New Zealand.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Gray
authors.affiliation: University of Otago Dunedin School of Medicine, Dunedin, New Zealand.
authors.forename: Tui H
authors.initials: TH
authors.lastname: Bevin
authors.affiliation: Dunedin Hospital, Dunedin, New Zealand.
authors.forename: Lyndell E
authors.initials: LE
authors.lastname: Kelly
authors.affiliation: University of Otago Dunedin School of Medicine, Dunedin, New Zealand.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Molteno
mesh_terms: D000074322:Antineoplastic Agents, Immunological / Q000008:administration & dosage; D000068258:Bevacizumab / Q000008:administration & dosage*; D002830:Choroid Neoplasms / Q000188:drug therapy / Q000628:therapy*; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008545:Melanoma / Q000188:drug therapy / Q000628:therapy*; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000074322:Antineoplastic Agents, Immunological; D000068258:Bevacizumab
keywords: bevacizumab; local neoplasm recurrence; melanoma; radiosurgery; retinal neovascularisation