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JR Gaitan, BC Hayden, TG Murray, EM Escalona, N Cicciarelli, W Feuer; Cellular Viability in Choroidal Melanoma Following Brachytherapy with Subsequent Enucleation . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1132.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate and compare the cellular viability in choroidal melanoma following brachytherapy in globes enucleated for suspected tumor recurrence/regrowth versus globes enucleated for any other complications. Methods: A review of 68 posterior uveal melanoma globes harvested intraoperatively for ex vivo cell viability analysis identified 9 specimens from patients that had undergone enucleation surgery for tumor recurrence or other ocular complications, previously treated with brachytherapy. Demographic data, clinical history and follow-up findings were obtained retrospectively from the medical records. Cellular viability of the residual tumor cells was assessed by in vitro cell culture and histopathologic evaluation. Other study variables included initial tumor size, treatment schedule, type of complications, reason for enucleation, time elapsed between treatment completion and enucleation surgery and presence of metastasis. Results: All nine patients received 125I brachytherapy utilizing an 85 Gy apical dose and a treatment margin ≥ 2mm. Six patients (overall 2% of melanoma patients at BPEI) were enucleated for tumor suspected recurrence/regrowth and three patients for uncontrollable neovascular glaucoma. One patient (1/6, 17%) with tumor recurrence developed metastatic disease. Of the six patients enucleated for tumor recurrence, five patients (5/6, 83%) had positive cellular viability of their residual choroidal melanoma. Of the three patients who were enucleated for complications related to therapy all (3/3, 100%) had negative cellular viability from the residual tumor specimens. Conclusion: Patients without clinical evidence of tumor recurrence/regrowth after radiation therapy are unlikely to have cellular viability in their residual tumors. Suspected tumor recurrence is most likely to disclose a viable tumor and treatment should be prompt and aggressive due to the risk of metastatic dissemination. Intraoperative tumor cell harvesting is effective in detecting tumor cell viability as a marker for recurrent choroidal melanoma tumor activity.
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