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Brian Tse, Yevgeniy Shildkrot, Matthew W Wilson; Enucleation After Iodine-125 Plaque Brachytherapy in Patients with Large Choroidal Melanomas. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5086. doi: https://doi.org/.
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Treatment of choroidal melanoma (CMM) with either iodine-125 (I125) plaque brachytherapy or enucleation yields similar survival outcomes. As such, we have used brachytherapy as primary treatment for large CMMs for more than a decade. Herein, we evaluate our cohort of patients with large CMM initially treated with plaque brachytherapy to determine rate of and factors associated with secondary enucleation.
A retrospective chart review of patients with large CMMs diagnosed and treated at our institution from January 1, 1988 to February 1 2013. Main outcome measures were need for secondary enucleation, local tumor recurrence, all cause mortality, development of metastases, initial apical tumor height and maximal basal diameter.
245 patients with large CMM were treated primarily with plaque brachytherapy. Local control was achieved in 230 patients (93.8%). Of the 15 patients (6.2%) with local recurrence, 8 underwent secondary enucleation and 7 deferred further treatment. In all, 37 patients (15.1%) underwent secondary enucleation. Reasons for secondary enucleation included: neovascular glaucoma or blind, painful eye (21); local tumor recurrence (8), and scleromalacia (3). All cause mortality was 116 (47.3%). Metastatic disease was seen in 68 (27.9%). Median time to death was 2.8 years (mean 3.6 +/- 2.7 (0.08-16.7)). Enucleation was performed more frequently in women (20.2% vs 10.3%; p=0.03). Rate of metastases (p>0.7) and death were not increased in patients undergoing enucleation, although time to death appeared to be prolonged in patients who were enucleated (5.6 years vs 3.2 years; p<0.0001). There was no significant difference (p>0.1) in baseline apical tumor height, maximal basal diameter, collar-button configuration, or age at diagnosis
In our cohort of patients with large CMM treated with primary plaque brachytherapy, 15.1% required secondary enucleation. This information allows us to better counsel our patients about the pros and cons of primary brachytherapy as opposed to primary enucleation, help to minimize the potential burden of additional surgical procedures, and improve quality of life.
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