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M.G. Parker, A.K. Vine, A. Tandon, K. Meyer, D. Musch, L. Niziol; Characteristics and Rate of Regression of Choroidal Melanoma Post Plaque Therapy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2250.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the sonographic features and measurements of regression of choroidal melanomas treated by plaque radiotherapy as they relate to metastatic disease and to overall mortality.
A retrospective case series review of 130 patients (130 eyes) with choroidal melanomas treated with I125 plaque therapy done by a single surgeon between 1990 and 12/2004 was performed. Each patient was followed clinically and ultrasonographicaly every 6 months post plaque therapy. Of the 130 patients, 14 patients were excluded from the study due to: missing 12 month data but had later data (7); died before 12 months from melanoma metastasis or other causes (2); enucleated before 12 months for various reasons (5). Of the 116 patients included, 115 had 12 month data (99.13%) with mean follow up of 41.9 months (SD = 27.0 months; Range = 0 to 132 months). Sonographic features recorded included: location (posterior, equator, peripheral); height; basal diameter; internal reflectivity; and internal vascularity. Clinical assessments included complete ocular exams including a dilated fundus examination and regular metastatic screening (liver function tests with or without CT abdominal imaging). Correlation between risk of liver metastasis or tumor related death with tumor initial height regression post plaque therapy was the primary outcome measured.
Mean tumor height at the time of plaque therapy of all patients was 4.82 mm (SD 2.28mm), at 6 months was 3.59mm (SD 1.96), and at 12 months was 2.85mm (SD 1.54). There were ten documented failures (liver metastasis or tumor related deaths) with a mean height before brachytherapy of 5.29mm (SD 2.72) vs. 4.78mm (SD 2.25) in the non–failure patients. At 6 months, the failure group had a 38% (1.76mm) decrease in height from baseline compared to 21% (1.20mm) for the non–failure patients (p value 0.026). At 12 months, the failure group had a 54% (2.41mm) decrease in height compared to 34% (1.79mm) decrease in the non–failure group (p value 0.036). There was one documented failure in the 50% of patients (55) with the least amount of change at 12 months while there were 7 failures in the 50% of patients (59) with the most amount of change at 12 months (p value 0.062).
6 and 12 month tumor height regression after I125 plaque therapy are statistically inversely correlated with liver metastatic rates and overall mortality rates. Early rapid regression is a negative predictive factor. This characteristic allows treating physicians and patients better prognostic information.
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