 |
|
Evidence-Based Estimates of Outcome in Patients Irradiated for Intraocular Melanoma
Evangelos Gragoudas, MD;
Wenjun Li, MS;
Michael Goitein, PhD;
Anne Marie Lane, MPH;
John E. Munzenrider, MD;
Kathleen M. Egan, DSc
Arch Ophthalmol. 2002;120:1665-1671.
Background Melanoma of the eye is the only potentially fatal ocular malignancy in adults. Until radiation therapy gained wide acceptance in the 1980s, enucleation was the standard treatment for the tumor. Long-term results after proton beam irradiation are now available.
Methods We developed risk score equations to estimate probabilities of the 4 principal treatment outcomes—local tumor recurrence, death from metastasis, retention of the treated eye, and vision loss—based on an analysis of 2069 patients treated with proton beam radiation for intraocular melanoma between July 10, 1975, and December 31, 1997. Median follow-up in surviving patients was 9.4 years.
Results Tumor regrowth occurred in 60 patients, and 95% of tumors (95% confidence interval, 93%-96%) were controlled locally at 15 years. Risk scores were developed for the other 3 outcomes studied. Overall, the treated eye was retained by 84% of patients (95% confidence interval, 80%-87%) at 15 years. The probabilities for vision loss (visual acuity worse than 20/200) ranged from 100% to 20% at 10 years and for death from tumor metastases from 95% to 35% at 15 years, depending on the risk group.
Conclusions High-dose radiation treatment was highly effective in achieving local control of intraocular melanomas. In most cases, the eye was salvaged, and functional vision was retained in many patients. The mortality rate was high in an identifiable subset of patients who may benefit from adjuvant therapies directed at microscopic liver metastases.
From the Retina Service, Massachusetts Eye and Ear Infirmary (Dr Gragoudas and Ms Lane), and the Department of Radiation Oncology, Massachusetts General Hospital (Drs Goitein and Munzenrider), Harvard Medical School, Boston; the Biostatistics Research Center, Tufts New England Medical Center, Boston (Mr Li); and the Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn (Dr Egan).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
REFERENCES
JOURNAL OF THE ICRU 2007;7:189-210.
Proton Therapy in Clinical Practice: Current Clinical Evidence
Brada et al.
JCO 2007;25:965-970.
FULL TEXT
Proton Beam Irradiation of Uveal Melanomas: The First 30 Years The Weisenfeld Lecture
Gragoudas
IOVS 2006;47:4666-4673.
FULL TEXT
Estimates of Ocular and Visual Retention Following Treatment of Extra-Large Uveal Melanomas by Proton Beam Radiotherapy.
Conway et al.
Arch Ophthalmol 2006;124:838-843.
ABSTRACT
| FULL TEXT
|
