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M. J. Davis, M. Currie, J. Kim, J. Cohen; Comparison of Enucleation and I-125 Plaque Brachytherapy in the Treatment of Choroidal Melanoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5779.
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To review the charts of patients diagnosed with choroidal melanoma treated with enucleation or plaque brachytherapy (iodine 125) and to compare tumor size, metastases rate and survival rate between these two groups. It will also compare visual acuity before and after plaque brachytherapy and compare the relationship between visual acuity and dosage of radiation.
Charts were reviewed for patients who had a diagnosis of choroidal melanoma and underwent enucleation or plaque brachytherapy. The final pathology report of the enucleated eyes was reviewed to confirm the diagnosis. Data collected included: age, sex, race, date of diagnosis, size of tumor, treatment method, date of surgery, visual acuity at diagnosis, date of metastases and date of death (if applicable). The plaque brachytherapy group also included final visual acuity after surgery and dose of radiation plaque.
Choroidal melanoma was diagnosed and treated in 74 patients from 1996 to 2005. 46 (62.2%) patients underwent plaque brachytherapy and 28 (37.8%) underwent enucleation. Seven of the plaque brachytherapy patients subsequently underwent enucleation (15.2% of plaque patients). The mean tumor volume of the enucleation group was 1504 mm3 and 889.3 mm3 in the plaque brachytherapy group (p=0.0259). Plaque brachytherapy patients that later had an enucleation had a mean volume of 1470 mm3 at diagnosis. Rate of metastase for plaque brachytherapy was 12.8%, for enucleation 17.6% and combined rate for all patients 15.7% (p = 1.0, Odds ratio=0.833). Time to metastases was not statistically significant [p=0.285 (Mantel-Cox) and 0.099 (Gehan-Breslow-Wilcoxon), Hazard ratio=0.52]. Death rates for plaque were 14.7%, for enucleation 10.0% and combined 11.9% (p=1.0, Odds ratio=1.324). The mean visual acuity at diagnosis for the plaque brachytherapy group was logMAR 0.3338 (~20/40) and the mean visual acuity after plaque was logMAR 0.8485 (~20/125) (p=0.0004). There was no correlation between dose of plaque radiation and final visual acuity. However, there was a trend for vision to decrease as radiation dose increased.
Patients with larger tumors had enucleation versus those with smaller tumors had plaque therapy. There was no statistically significant difference in metastases rate or survival rate between the enucleation and plaque brachytherapy groups. However there was a trend for plaque patients to have a lower rate of metastases but a higher rate of mortality. Visual acuity declines significantly after plaque brachytherapy, although the radiation dose does not seem to have a significant effect.
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