Abstract
Purpose: :
To evaluate intravitreal bevacizumab as an adjuvant treatment to plaque brachytherapy in the treatment of choroidal melanoma.
Methods: :
This is an IRB-approved, retrospective, consecutive case series of 139 patients treated from 2007 - 2009 for choroidal melanoma with plaque brachytherapy. Patients were treated with iodine-125 plaque brachytherapy with 2 mm margins and 85 Gy to the tumor apex. Consecutive patients were injected with 2.5mg/0.1cc bevacizumab at a site away from the primary tumor and immediately following plaque removal. Choroidal melanomas were observed with indirect ophthalmoscopy, wide-angle photography, and ultrasound
Results: :
There were 15 cases excluded secondary to lack of documented follow-up, resulting in 124 patients for analysis. Mean patient age was 65.7 years, with mean tumor apical height of 4.0 mm (SD 2.7) and basal diameter of 12.7 mm (SD 3.0). Mean follow-up was 24 months. Prior to treatment, 100% of tumors had exudative retinal detachments, and pre-treatment visual acuity was 20/100. Tumor control was 100% and metastasis was 0% at last follow-up. 89.8% had complete resolution of exudative retinal detachment (ERD), with a mean time to resolution of 3.36 months. At 1 month, 43% had complete resolution of ERD, which increased to 73% at 4 months. Visual acuity improved to 20/40 at 3 months, 20/40 at 6 months, 20/30 at 12 months, and 20/50 at 24 months. Tumor burden was shown to be reduced 22.2% at 3 months, 28.9% at 6 months, 39.3% at 12 months, and 52.2% at 24 months (all P < 0.001). Patients tolerated the procedure well without systemic side effects and minimal local side effects.
Conclusions: :
Intravitreal bevacizumab may be used as an adjuvant agent when used following plaque brachytherapy. Treated choroidal melanomas show reduction in tumor burden as well as exudative retinal detachments.
Keywords: tumors • radiation therapy • choroid