Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes

Journal Article · Thu May 01 04:00:00 EDT 2014 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2014.01.026· OSTI ID:22416555

Perez, Bradford A. ^[1]; Mettu, Pradeep; Vajzovic, Lejla ^[2]; Rivera, Douglas ^[3]; Alkaissi, Ali; Steffey, Beverly A.; Cai, Jing ^[1]; Stinnett, Sandra ^[4]; Dutton, Jonathan J. ^[5]; Buckley, Edward G. ^[2]; Halperin, Edward ^[6]; Marks, Lawrence B. ^[7]; Mruthyunjaya, Prithvi ^[1]

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1. Department of Radiation Oncology, Duke University, Durham, North Carolina (United States)
2. Department of Ophthalmology, Duke University, Durham, North Carolina (United States)
3. Austin Cancer Centers, Austin, Texas (United States)
4. Department of Biostatistics and Informatics, Duke University, Durham, North Carolina (United States)
5. Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina (United States)
6. Department of Radiation Oncology, New York Medical College, Valhalla, New York (United States)
7. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)

Purpose: To investigate, in the treatment of uveal melanomas, how tumor control, radiation toxicity, and visual outcomes are affected by the radiation dose at the tumor apex. Methods and Materials: A retrospective review was performed to evaluate patients treated for uveal melanoma with {sup 125}I plaques between 1988 and 2010. Radiation dose is reported as dose to tumor apex and dose to 5 mm. Primary endpoints included time to local failure, distant failure, and death. Secondary endpoints included eye preservation, visual acuity, and radiation-related complications. Univariate and multivariate analyses were performed to determine associations between radiation dose and the endpoint variables. Results: One hundred ninety patients with sufficient data to evaluate the endpoints were included. The 5-year local control rate was 91%. The 5-year distant metastases rate was 10%. The 5-year overall survival rate was 84%. There were no differences in outcome (local control, distant metastases, overall survival) when dose was stratified by apex dose quartile (<69 Gy, 69-81 Gy, 81-89 Gy, >89 Gy). However, increasing apex dose and dose to 5-mm depth were correlated with greater visual acuity loss (P=.02, P=.0006), worse final visual acuity (P=.02, P<.0001), and radiation complications (P<.0001, P=.0009). In addition, enucleation rates were worse with increasing quartiles of dose to 5 mm (P=.0001). Conclusions: Doses at least as low as 69 Gy prescribed to the tumor apex achieve rates of local control, distant metastasis–free survival, and overall survival that are similar to radiation doses of 85 Gy to the tumor apex, but with improved visual outcomes.

• OSTI ID: 22416555
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 89; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
IODINE 125
MELANOMAS
METASTASES
MULTIVARIATE ANALYSIS
PATIENTS
RADIATION DOSES
REVIEWS
TOXICITY