Benjamin King1, Vanessa M Morales-Tirado2, Henry G Wynn1, Brad T Gao1, Matthew T Ballo3, Matthew W Wilson4. 1. Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee. 2. Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee. 3. Department of Radiation Oncology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee. 4. Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee; Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: mwilson5@uthsc.edu.
Abstract
PURPOSE: To report the outcomes of survival, local control, visual acuity, and eye retention in patients treated with repeat episcleral plaque brachytherapy (EPBT) for locally recurrent posterior uveal melanoma (PUM). DESIGN: Retrospective, interventional case series. METHODS: Setting: Institutional. PATIENT POPULATION: A total of 1201 patients that underwent iodine-125 (I-125) EPBT as primary treatment for PUM between 1985 and 2015. INCLUSION CRITERIA: Development of locally recurrent disease and retreatment with I-125 EPBT. OBSERVATION PROCEDURES: Clinical records review. MAIN OUTCOME MEASURES: Visual acuity, Kaplan-Meier estimates of survival, local control, metastasis, and loss of the eye over the duration of follow-up. RESULTS: Twenty-seven patients (13 men) met our inclusion criteria. Median (range) follow-up from initial treatment was 100 months (14-365 months), while median time to local recurrence was 43 months (9-185 months). Median (range) follow-up after retreatment was 47 months (3-120 months). Kaplan-Meier estimate for local control at 5 years was 77.2% (95% confidence interval [CI], 53.29%-89.91%). All marginal recurrences were successfully retreated whereas 6 of 15 patients with central recurrence developed subsequent re-recurrence following salvage EPBT. Median (range) visual acuity was 20/70 (20/20 to counting fingers at 1 foot) at time of recurrence and declined to counting fingers (20/25 to hand motion) at the most recent follow-up examination. Kaplan-Meier estimate for absence of metastatic disease at 5 years was 78.5% (95% CI, 54.77%-90.70%). CONCLUSIONS: Repeat I-125 EPBT offers a viable alternative to enucleation in patients with local recurrence of PUM, yielding high rates of local control with predictable decline in visual acuity.
PURPOSE: To report the outcomes of survival, local control, visual acuity, and eye retention in patients treated with repeat episcleral plaque brachytherapy (EPBT) for locally recurrent posterior uveal melanoma (PUM). DESIGN: Retrospective, interventional case series. METHODS: Setting: Institutional. PATIENT POPULATION: A total of 1201 patients that underwent iodine-125 (I-125) EPBT as primary treatment for PUM between 1985 and 2015. INCLUSION CRITERIA: Development of locally recurrent disease and retreatment with I-125 EPBT. OBSERVATION PROCEDURES: Clinical records review. MAIN OUTCOME MEASURES: Visual acuity, Kaplan-Meier estimates of survival, local control, metastasis, and loss of the eye over the duration of follow-up. RESULTS: Twenty-seven patients (13 men) met our inclusion criteria. Median (range) follow-up from initial treatment was 100 months (14-365 months), while median time to local recurrence was 43 months (9-185 months). Median (range) follow-up after retreatment was 47 months (3-120 months). Kaplan-Meier estimate for local control at 5 years was 77.2% (95% confidence interval [CI], 53.29%-89.91%). All marginal recurrences were successfully retreated whereas 6 of 15 patients with central recurrence developed subsequent re-recurrence following salvage EPBT. Median (range) visual acuity was 20/70 (20/20 to counting fingers at 1 foot) at time of recurrence and declined to counting fingers (20/25 to hand motion) at the most recent follow-up examination. Kaplan-Meier estimate for absence of metastatic disease at 5 years was 78.5% (95% CI, 54.77%-90.70%). CONCLUSIONS: Repeat I-125 EPBT offers a viable alternative to enucleation in patients with local recurrence of PUM, yielding high rates of local control with predictable decline in visual acuity.
Authors: Luca Tagliaferri; Monica Maria Pagliara; Bruno Fionda; Andrea Scupola; Luigi Azario; Maria Grazia Sammarco; Rosa Autorino; Valentina Lancellotta; Silvia Cammelli; Carmela Grazia Caputo; Rafael Martinez-Monge; György Kovács; Maria Antonietta Gambacorta; Vincenzo Valentini; Maria Antonietta Blasi Journal: J Contemp Brachytherapy Date: 2019-02-28