Abstract
Purpose :
Uveal melanoma (UM), the most common primary intraocular tumor in adults, is usually treated by local irradiation (brachytherapy) with radioactive plaques or by external irradiation via different modalities, depending on tumor characteristics. This study compared treatment results with fractionated stereotactic radiosurgery (FSR) versus full-dose stereotactic radiosurgery (SRS).
Methods :
A retrospective study was performed reviewing the medical files of 66 patients that underwent FSR/SRS due to uveal melanoma between the years 2007-2019. Data included age, gender, dates of diagnosis and treatments, initial and final tumor size, tumor location, previous treatments, disease progression including local recurrence and metastatic spread, mortality rates, enucleation rates, and adverse effects, including radiation retinopathy, neovascular glaucoma, and optic neuropathy. Descriptive statistics were analyzed with JMP statistical package.
Results :
Sixty-seven UM patients (26 (39.4%) women) were treated with FSR or SRS (33 or 33, respectively). FSR was performed between 2009-2016, while SRS was performed between 2017-2022. 71% of the tumors were choroidal, 23% cilio-choroidal and 3% irido-cilio-choroidal. 71.2% of the tumors were previously treated by brachytherapy, with only 1 (3.0%) primary treatment with FSR vs. 18 (54.5%) with SRS. The mean (±SD) reduction in tumor height and volume was 27.0% (±25.2%) and 35.7% (±33.0%), respectively. Tumors treated primarily with SRS/FSR were wider than tumors treated receiving SRS/FSR as a secondary treatment (p<0.001) but their pre-treatment height and volume did not differ statistically (p>0.2), nor did the post-treatment reduction in tumor height and volume (p>0.15). Tumors treated by FSR lost more height (59.6% vs. 47.0%, p=0.047) but not more volume (35.8 vs. 28.9%, p=0.418) than tumors treated by SRS, yet with much longer follow-up (62.2 (±46.4) months (FSR) and 26.1 (±19.3) months (SRS), p<0.0001). Local recurrence after FSR/SRS was seen in 8 (12%) cases (6.1% for FSR vs. 18.2% for SRS). 22 (33.3%) developed NVG (39.4%-FSR vs. 27.3%-SRS, likelihood ratio p=0.337), resulting in enucleation in 10 (45.4%) of them (15.2% of the entire group).
Conclusions :
FSR and SRS appear to provide similar good local control rates for uveal melanoma as primary and secondary treatments, albeit with similar considerable side effects.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.