The Collaborative Ocular Melanoma Study, mortality by therapeutic approach, age and tumor size.

OBJECTIVES: Determine the mortality ratios and excess deaths associated with the two therapeutic options for both the small and the large tumor groups and for subsets of age and tumor size within each group as presented in the Collaborative Ocular Melanoma Study (COMS).
METHODS: Mortality ratios and excess deaths are determined using standard mortality methodology. Expectant mortality is determined from appropriate general population life mortality tables.
RESULTS: The smaller tumor group comparing brachytherpy to enucleation revealed similar mortality ratios (MR) of 134% and 137% for each treatment approach and respective Total Excess Deaths per Thousand (Total ED/K) of 131 and 128. The larger tumor group comparing results of pre-enucleation radiation therapy (PERT) followed by enucleation to enucleatic alone revealed respective mortality ratios of 291% and 305% and Total ED/K of 520 and 547. Those over 60 years of age having a maximum basal tumor diameter (MBTD) < or = 11 mm had MR = 101% and Total ED/K = 26, the best mortality experience in the study. Those over 60 years of age had better relative mortality, depending on the MBTD, when compared to the younger group.
CONCLUSIONS: Mortality associated with ocular melanoma does not vary according to whether brachytherapy (smaller melanomas) or PERT followed by enucleation (larger melanomas) is used vs simple enucleation. Mortality increases as the MBTD increases.