This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (39)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Ocular/ Adnexal Tumors  • Dermatology  • Radiation Therapy  • Melanoma  • Alert me on articles by topic

Kaan Gündüz, MD; Carol L. Shields, MD; Jerry A. Shields, MD; Jacqueline Cater, PhD; Jorge E. Freire, MD; Luther W. Brady, MD

Arch Ophthalmol. 1999;117:609-614.

Objective  To identify the risk factors that lead to the development of radiation retinopathy following plaque radiotherapy for posterior uveal melanoma. Radiation retinopathy is a slowly progressive, occlusive vasculopathy characterized by radiation-induced endothelial damage.

Methods  Review of the medical records of patients with posterior uveal melanoma treated with plaque radiotherapy.

Results  Of 1300 patients with posterior uveal melanoma treated with plaque radiotherapy from July 1, 1976, through June 30, 1992, radiation retinopathy developed in 560 (43.1%). By using Kaplan-Meier survival estimates, we found that 5% of the patients had nonproliferative radiation retinopathy at 1 year (95% confidence interval [CI], 3%-6%) and 42% at 5 years (95% CI, 38%-45%). The proportion of patients with proliferative retinopathy was 1% at 1 year (95% CI, 0.2%-1.5%) and 8% at 5 years (95% CI, 5%-10%). Multivariate analyses showed that the subset of clinical variables best related to the development of nonproliferative radiation retinopathy were tumor margin of less than 4 mm from foveola (P<.001), tumor limited to the choroid (P=.002), and radiation dose rate of greater than 260 cGy/h to the tumor base (P=.02). The best subset of independent variables related to the development of radiation maculopathy were tumor of less than 4 mm to foveola (P<.001) and the use of radioisotope iridium 192 (¹⁹²Ir) (P=.02) compared with iodine 125 (¹²⁵I). From a multivariate model, the most important factors for the development of proliferative radiation retinopathy included diabetes mellitus (P=.01), radioisotope ¹⁹²Ir (P=.01) compared with ¹²⁵I, and tumor base of greater than 10 mm (P=.02).

Conclusions  Radiation retinopathy is a common finding after plaque radiotherapy for choroidal melanoma, occurring in 42% of patients at 5 years. The main predictors of radiation retinopathy are posterior tumor location with margin near the foveola and high radiation dose rate to the tumor base.

From the Oncology Service, Wills Eye Hospital, Thomas Jefferson University (Drs Gündüz, C. L. Shields, J. A. Shields, and Cater), and the Department of Radiation Oncology, Allegheny University Health System at Hahnemann (Drs Freire and Brady), Philadelphia, Pa.

RELATED ARTICLE

Archives of Ophthalmology Reader's Choice: Continuing Medical Education
Arch Ophthalmol. 1999;117(5):707-708.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Posterior uveal melanoma. Distribution of the sites of origin and patterns of tumour extent in the ocular fundus
Krohn et al.
Br. J. Ophthalmol. 2008;92:751-756.
ABSTRACT | FULL TEXT  

Histopathologic Characteristics of Choroidal Melanoma in Eyes Enucleated After Iodine 125 Brachytherapy in the Collaborative Ocular Melanoma Study
Avery et al.
Arch Ophthalmol 2008;126:207-212.
ABSTRACT | FULL TEXT  

Laser photocoagulation for radiation retinopathy after ophthalmic plaque radiation therapy
Finger and Kurli
Br. J. Ophthalmol. 2005;89:730-738.
ABSTRACT | FULL TEXT  

Combined plaque radiotherapy and transpupillary thermotherapy in choroidal melanoma: 5 years' experience
Bartlema et al.
Br. J. Ophthalmol. 2003;87:1370-1373.
ABSTRACT | FULL TEXT  

Evidence-Based Estimates of Outcome in Patients Irradiated for Intraocular Melanoma
Gragoudas et al.
Arch Ophthalmol 2002;120:1665-1671.
ABSTRACT | FULL TEXT  

Combined Plaque Radiotherapy and Transpupillary Thermotherapy for Choroidal Melanoma: Tumor Control and Treatment Complications in 270 Consecutive Patients
Shields et al.
Arch Ophthalmol 2002;120:933-940.
ABSTRACT | FULL TEXT  

Adoptive T Cell Immunotherapy of Human Uveal Melanoma Targeting gp100
Sutmuller et al.
J. Immunol. 2000;165:7308-7315.
ABSTRACT | FULL TEXT  

Plaque Radiotherapy for Uveal Melanoma: Long-term Visual Outcome in 1106 Consecutive Patients
Shields et al.
Arch Ophthalmol 2000;118:1219-1228.
ABSTRACT | FULL TEXT  

Tumour location affects the incidence of cataract and retinopathy after ophthalmic plaque radiation therapy
Finger
Br. J. Ophthalmol. 2000;84:1068-1070.
ABSTRACT | FULL TEXT