Retrospective analysis of the management outcomes of uveal melanomas at the new Cairo University ocular oncology service

Abstract

Purpose : To investigate the demographic data & interventional clinical outcomes of patients presenting to the new Cairo University ocular oncology service with uveal melanomas.

Methods : This was a retrospective analysis of the medical records of patients managed for choroidal & ciliochoroidal melanomas. We reviewed the demographic data & different management modalities, compared the ultrasound measurements of the tumors before and after intervention and analyzed the complications & failure rates.

Results : 41 eyes of 41 patients were included. 30 eyes were managed with episcleral Ruthenium-106 plaque radiotherapy, or brachytherapy, of which four eyes were considered failures. One of the four eyes developed a rhegmatogenous retinal detachment & endophthalmitis necessitating pars plana vitrectomy that ended in exenteration due to extrascleral extension, while the remaining three eyes were enucleated due to progression in the tumor dimensions, demonstrating a failure rate of 13.3%. 10 of the remaining 11 eyes were enucleated based on the large baseline tumor size, while the eleventh eye showed extrasceleral extension necessitating exenteration. The mean age of the brachytherapy group was 56.4 +/- 12.1 years, while the enucleation & exenteration group was 50.2 +/-11.5 years (p = 0.18). Mean baseline dimensions for the brachytherapy group was 5.52 +/-2.1 mm height & 9.42 +/-3.2 mm diameter, while the enucleation group was 10.52 +/-3.49 mm height & 13.79 +/- 3.18 mm diameter. (p <0.001 & <0.01, respectively). For the brachytherapy group, the mean duration of plaque application was 7.02 +/- 4.06 days & the mean delivered radiation dose was 113.34 +/-5.3 Grey. Mean final sonographic follow up periods for the brachytherapy group was 26.4 +/- 16.16 weeks, with the mean height at 4.83 +/- 2.4 mm & base diameter at 8.12 +/- 3.36 mm. (p = 0.24 & 0.182, respectively). None of the patients demonstrated metastatic spread on serial Pan or PET/CT.

Conclusions : Timely referral & accurate clinical & investigative assessment of cases with uveal melanomas are invaluable for achieving higher success rates of tumor regression, as well as ocular and/or visual preservation in eyes managed with brachytherapy. Patients with more advanced tumors should be counseled on the importance of more invasive techniques, such as enucleation & exenteration for achieving lower malignancy dissemination & mortality rates.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.