Plaque radiotherapy for juxtapapillary choroidal melanoma. Visual acuity and survival outcome
P. De Potter, C. L. Shields, J. A. Shields, J. R. Cater and L. W. Brady
Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pa, USA.
OBJECTIVES: To assess the effect of plaque radiotherapy on the visual
acuity of patients with juxtapapillary choroidal melanoma and to determine
the clinical predictive factors for radiation retinopathy, radiation
papillopathy, local tumor recurrence, and distant metastasis. DESIGN: A
retrospective review of the medical records of 93 patients with
juxtapapillary choroidal melanoma who were treated initially with plaque
radiotherapy. RESULTS: During a mean follow-up of 78 months, radiation
retinopathy developed in 81 patients (87%) and radiation papillopathy
developed in 48 patients (52%) after a mean interval of 21 and 27 months,
respectively. The univariate variables that were significant predictors of
radiation retinopathy were history of diabetes mellitus (P = .05) and use
of a notched radioactive plaque (P = .04). The factors predictive of
radiation papillopathy were age (> 45 years; P = .01), history of
diabetes mellitus (P = .05), mushroom-shaped tumor configuration (P =
.006), and nasal location of the tumor (P = .04). By using Kaplan-Meier
survival curves, we found that the proportion of the 93 patients with
radiation retinopathy was 87 (94%) at 5 years and with radiation
papillopathy was 53 (57%) at 5 years. By using life-table analysis, we
found that the proportion of the 93 patients who experienced a decrement of
at least 3 lines of visual acuity was 67 (72%) by 50 to 60 months. Local
tumor recurrence was documented in 14 patients (15%) after a mean interval
of 41 months. The age of the patient (< 35 years; P = .02) and the
superior (P = .004) and inferior (P = .05) locations of the tumor were
predictive of local tumor recurrence. Distant metastasis developed in 11
patients (12%) after a mean interval of 44 months. The factors predictive
of distant metastasis were a tumor with a basal diameter larger than 6.0 mm
(P = .05), the superior location of the tumor (P = .01), and local tumor
recurrence (P < .001). CONCLUSION: Based on these observations, plaque
radiotherapy remains a potential option vs enucleation for the management
of juxtapapillary choroidal melanoma.
