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Tumor Control and Treatment Complications in 270 Consecutive Patients

Carol L. Shields, MD; Jacqueline Cater, PhD; Jerry A. Shields, MD; Aning Chao, MD; Hatem Krema, MD; Miguel Materin, MD; Luther W. Brady, MD

Arch Ophthalmol. 2002;120:933-940.

Objective  To evaluate tumor control and treatment complications following plaque radiotherapy combined with transpupillary thermotherapy for choroidal melanoma.

Design  Prospective noncomparative interventional case series.

Intervention  All patients received treatment for choroidal melanoma using plaque radiotherapy followed by 3 sessions of transpupillary thermotherapy provided at plaque removal and at 4-month intervals.

Participants  Two hundred seventy patients with newly diagnosed choroidal melanoma.

Main Outcome Measures  The 2 main outcome measures included local tumor recurrence and treatment-related complications. The clinical data regarding patient features, tumor features, radiotherapy and thermotherapy parameters were analyzed for their effect on the 2 main outcomes using Cox proportional hazards regression models.

Results  Prior to treatment, the median base of the tumor was 11 mm (range, 4-21 mm) and the median thickness was 4 mm (range, 2-9 mm). Most tumors were located in the posterior pole with a median proximity of 2 mm to the foveola and 2 mm to the optic disc. The median radiotherapy dose to the tumor apex was 9000 rad. Transpupillary thermotherapy was applied in 3 sessions at 4-month intervals for a median of 700 mW. The tumor decreased in thickness to a median of 2.3 mm by 1 year and 2.1 mm by 2 years' follow-up with stable findings thereafter. Using Kaplan-Meier estimates, tumor recurrence was 2% at 2 years and 3% at 5 years. Risk factors for tumor recurrence included macular location of the tumor epicenter (P = .03), diffuse tumor configuration (P = .005), and tumor margin extending underneath the foveola (P = .001). Using Kaplan-Meier estimates, treatment-related complications at 5 years included maculopathy in 18% of the participants, papillopathy in 38%, macular retinal vascular obstruction in 18%, vitreous hemorrhage in 18%, rhegmatogenous retinal detachment in 2%, cataract in 6%, and neovascular glaucoma in 7%. Enucleation for radiation complications was necessary in 3 cases (1%).

Conclusion  Plaque radiotherapy combined with transpupillary thermotherapy provides excellent local tumor control with only 3% recurrence at 5 years' follow-up.

From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University (Drs C. L. Shields, Cater, J. A. Shields, Chao, Krema, and Materin); and the Department of Radiation Oncology, Medical College of Pennsylvania, Hahnemann University (Dr Brady), Philadelphia. The authors have no commercial, proprietary, or financial interest in any of the products or companies described in this article.

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