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      Choroidal Melanoma with Ultrasound-Guided Episcleral Brachytherapy: Long-Term Results and Risk of Metastasis

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          Abstract

          Introduction: The aim of this study was to elucidate the long-term outcomes in patients with choroidal melanoma who received episcleral brachytherapy with 125-I seeds; analyse cause-specific survival (CSS), metastasis-free survival (MFS), and local control; and establish the relationship between tumour size and metastases. Methods: From May 2007 to February 2013, 88 patients classified according to the American Joint Committee on Cancer guidelines underwent ultrasound-guided episcleral brachytherapy with a total prescribed dose of 72.40 Gy to the apex. Results: Among the included cases, 47.7 and 44.3% had a clinical tumour stage of T2 and T3, respectively. With a median follow-up of 84 (range 7–153) months, local control at 5 and 10 years was 100 and 95%, respectively. Among the 88 patients, 9 (10.2%) were enucleated after brachytherapy. Those with T1–T2 and T3–T4 disease had a 10-year CSS of 100 and 87.3%, respectively ( p = 0.017). MFS at 5 and 10 years was 100% in those with T1–T2 disease and 92.1 and 83.1% in those with T3–T4, respectively ( p = 0.016). Five patients had liver metastases, all of whom had T3–T4 disease. Conclusion: Ultrasound-guided episcleral brachytherapy with 125-I seeds yielded excellent local control for choroidal melanoma, with low complication rates and 90% eye preservation. Given the association between tumour stage and liver metastases, which remain the main cause of death, stricter control should be employed for T3–T4 tumours for the early detection and treatment of relapses.

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          Gene expression profiling in uveal melanoma reveals two molecular classes and predicts metastatic death.

          Michael Onken, Lori A Worley, Justis P Ehlers … (2004)
          Melanomas are notoriously difficult to classify because of a lack of discrete clinical and pathological stages. Here, we show that primary uveal melanomas surprisingly cluster into two distinct molecular classes based on gene expression profile. Genes that discriminate class 1 (low-grade) from class 2 (high-grade) include highly significant clusters of down-regulated genes on chromosome 3 and up-regulated genes on chromosome 8q, which is consistent with previous cytogenetic studies. A three-gene signature allows biopsy-size tumor samples to be assigned accurately to tumor classes using either array or PCR platforms. Most importantly, this molecular classification strongly predicts metastatic death and outperforms other clinical and pathological prognostic indicators. These studies offer new insights into melanoma pathogenesis, and they provide a practical foundation for effective clinical predictive testing.
          Article 0 comments Cited 182 times – based on 0 reviews     Review now
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            The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28.

            (2006)
            To report refined rates of death and related outcomes by treatment arm through 12 years after primary treatment of choroidal melanoma and to evaluate characteristics of patients and tumors as predictors of relative treatment effectiveness and time to death. Randomized multicenter clinical trial of iodine 125 ((125)I) brachytherapy vs enucleation conducted as part of the Collaborative Ocular Melanoma Study. Eligible patients were free of metastasis and other cancers at enrollment. All patients were followed up for 5 to 15 years at scheduled examinations for metastasis or another cancer or until death. Decedents were classified by the independent Mortality Coding Committee as having histopathologically confirmed melanoma metastasis, suspected melanoma metastasis without histopathologic confirmation, another cancer but not melanoma metastasis, or no malignancy. Deaths from all causes and deaths with histopathologically confirmed melanoma metastasis. Within 12 years after enrollment, 471 of 1317 patients died. Of 515 patients eligible for 12 years of follow-up, 231 (45%) were alive and clinically cancer free 12 years after treatment. For patients in both treatment arms, 5- and 10-year all-cause mortality rates were 19% and 35%, respectively; by 12 years, cumulative all-cause mortality was 43% among patients in the (125)I brachytherapy arm and 41% among those in the enucleation arm. Five-, 10-, and 12-year rates of death with histopathologically confirmed melanoma metastasis were 10%, 18%, and 21%, respectively, in the (125)I brachytherapy arm and 11%, 17%, and 17%, respectively, in the enucleation arm. Older age and larger maximum basal tumor diameter were the primary predictors of time to death from all causes and death with melanoma metastasis. Longer follow-up of patients confirmed the earlier report of no survival differences between patients whose tumors were treated with (125)I brachytherapy and those treated with enucleation. Estimated mortality rates by baseline characteristics should facilitate counseling of patients who have choroidal melanoma of a size and in a location suitable for enucleation or (125)I brachytherapy and no evidence of metastasis or another malignancy.
            Article 0 comments Cited 148 times – based on 0 reviews     Review now
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              Incidence of uveal melanoma in Europe.

              Emanuele Crocetti, , Eugenio Paci … (2007)
              To estimate incidence rates of uveal melanoma in Europe from 1983 to 1994. Incidence analysis of data from cancer registries adhering to the European Cancer Registry-based study on survival and care of cancer patients (EUROCARE) (cases diagnosed from 1983 to 1994). Data of 6673 patients with ocular melanoma (as defined by International Classification of Diseases for Oncology morphology codes 8720 to 8780 [melanoma] and International Classification of Diseases 9 (ICD9) codes 190.0 [iris and ciliary body], 190.5 [retina], 190.6 [choroid], and 190.9 [unspecified ocular location]) from 33 cancer registries of 16 European countries. Incidence rate ratios (IRRs) were obtained from a multilevel Poisson regression model. Incidence rates and IRRs associated with demographic and geographic variables. Standardized incidence rates increased from south to north across registries, from a minimum of 8 per million in Norway and Denmark. The inclusion of tumors with unspecified ocular location (code 190.9) increased incidence rates in most United Kingdom registries, but not in the other geographic areas, where this code was seldom used for uveal melanomas. Incidence increased noticeably up to age 55 (IRR, 1.46 per 5 years; 95% confidence interval [CI], 1.36-1.57) but leveled off after age 75 (IRR, 0.99 per 5 years; 95% CI, 0.93-1.05), with intermediate levels midway (IRR, 1.18 per 5 years; 95% CI, 1.12-1.23). It was also higher in males (IRR, 1.22; 95% CI, 1.16-1.28). Rates were stable during the study period, but a cohort effect was evidenced, accounting for higher incidence rates in people born during the period 1910 to 1935 (P = 0.005). Incidence increased with latitude (P = 0.008), which explained most differences in rates among areas. In this large series of uveal melanomas, we found stable incidence during the years 1983 to 1994. The north-to-south decreasing gradient supports the protective role of ocular pigmentation. European ophthalmologists should develop guidelines to standardize the coding of tumors treated conservatively using the ICD classification to improve the registration and surveillance of uveal melanoma by cancer registries.
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                Author and article information

                Journal
                Journal ID (publisher-id): OOP
                Journal ID (pmc): OOP
                Journal ID (doi): 10.1159/issn.2296-4657
                Title: Ocular Oncology and Pathology
                Publisher: S. Karger AG
                ISSN (Print): 2296-4681
                ISSN (Electronic): 2296-4657
                Publication date Subscription-year: 2021
                Publication date (Print): September 2021
                Publication date (Electronic): 05 May 2021
                Volume: 7
                Issue: 4
                Pages: 280-286
                Affiliations
                [_a] aDepartment of Radiation Oncology, Fundacion Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain
                [_b] bDepartment of Ophthalmology, FISABIO Oftalmología, Valencia, Spain
                [_c] cDepartment of Radiation Physics, Fundacion Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain
                Author information
                https://orcid.org/0000-0002-5806-4854
                Article
                Publisher ID: 514649 Other ID: Ocul Oncol Pathol 2021;7:280–286
                DOI: 10.1159/000514649
                SO-VID: 505c3a5c-1f67-4c05-85d9-162db16e90c3
                Copyright © © 2021 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 18 November 2020
                Date accepted : 21 January 2021
                Page count
                Figures: 3, Tables: 2, Pages: 7
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Local control,Metastasis-free survival,Brachytherapy,Choroidal melanoma,125-I
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Local control, Metastasis-free survival, Brachytherapy, Choroidal melanoma, 125-I

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