NYMC Faculty Publications

Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes

Author Type(s)

Faculty

Journal Title

International Journal of Radiation Oncology, Biology, Physics

First Page

127

Last Page

136

Document Type

Article

Publication Date

5-1-2014

Department

Radiation Medicine

Second Department

Pediatrics

Keywords

Adult, Aged, Analysis of Variance, Brachytherapy, Choroid Neoplasms, Ciliary Body, Disease-Free Survival, Eye Enucleation, Female, Humans, Iodine Radioisotopes, Linear Models, Male, Melanoma, Middle Aged, Neoplasm Recurrence, Local, Radiotherapy Dosage, Retrospective Studies, Sclera, Treatment Failure, Tumor Burden, Uveal Neoplasms, Visual Acuity, Uveal Melanoma

Disciplines

Medicine and Health Sciences

Abstract

PURPOSE: 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 AND MATERIALS: 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.

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