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Pattern of Local Recurrence After I-125 Episcleral Brachytherapy for Uveal Melanoma in a Spanish Referral Ocular Oncology Unit

      Purpose

      To describe the time, frequency, and clinical characteristics of treatment failure after I-125 brachytherapy in patients with uveal melanoma treated and followed in a Spanish referral ocular oncology unit.

      Design

      Prospective, consecutive, interventional case series.

      Methods

      Patients diagnosed with uveal melanoma from 1995 to 2016 and treated with episcleral brachytherapy were included. Demographic data collection, ophthalmic evaluation, ultrasound scan, and systemic studies were performed at baseline, every 6 months thereafter for 5 years, and subsequently at annual intervals. Recurrence was defined as presence of tumor growth after treatment. Baseline analysis was performed by descriptive methods and survival by Kaplan-Meier curves.

      Results

      From 732 patients diagnosed with uveal melanoma, 311 were treated with brachytherapy. In the follow-up (mean 79 months, standard deviation = 55), 16 local tumor recurrences (5.1%) were detected. All relapsing patients had choroidal tumors and 15 presented with visual symptoms. All patients were treated with I-125 brachytherapy, and 2 received associated transpupillary thermotherapy. All the eyes were enucleated after recurrence. Kaplan-Meier analysis showed a mean time of recurrence of 3.7 years (standard deviation = 2.94 years, ranging from 1 to 12 years). Three patients had metastasis in the follow-up. Kaplan-Meier analysis showed worse survival for patients with recurrence.

      Conclusion

      Local treatment failure was a relatively infrequent event after I-125 brachytherapy in our series. Recurrences appear not only early but also late in the follow-up. They do not have a distinctive clinical pattern and are associated with poorer survival.
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      References

        • Singh A.D.
        • Damato B.E.
        • Pe'er J.
        • et al.
        Essentials of Ophthalmic Oncology.
        Slack Incorporated, Thorofare, New Jersey2009: 288
        • McLaughlin C.C.
        • Wu X.C.
        • Jemal A.
        • et al.
        Incidence of noncutaneous melanomas in the U.S..
        Cancer. 2005; 103: 1000-1007
        • Weis E.
        • Shah C.P.
        • Lajous M.
        • Shields J.A.
        • Shields C.L.
        The association between host susceptibility factors and uveal melanoma: a meta-analysis.
        Arch Ophthalmol. 2006; 124: 54-60
        • Virgili G.
        • Gatta G.
        • Ciccolallo L.
        • et al.
        Incidence of uveal melanoma in Europe.
        Ophthalmology. 2007; 114: 2309-2315.e2
        • Jampol L.M.
        • Moy C.S.
        • Murray T.G.
        • et al.
        The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma. IV. Local treatment failure and enucleation in the first 5 years after brachytherapy. COMS report No. 19.
        Ophthalmology. 2002; 109: 2197-2206
        • Collaborative Ocular Melanoma Study Group
        The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28.
        Arch Ophthalmol. 2006; 124: 1684-1693
        • Diener-West M.
        • Earle J.D.
        • Fine S.L.
        • et al.
        • Collaborative Ocular Melanoma Study Group
        The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings. COMS Report No. 18.
        Arch Ophthalmol. 2001; 119: 969-982
        • Chang M.Y.
        • McCannel T.A.
        Local treatment failure after globe-conserving therapy for choroidal melanoma.
        Br J Ophthalmol. 2013; 97: 804-811
        • Vrabec T.R.
        • Augsburger J.J.
        • Gamel J.W.
        • et al.
        Impact of local tumor relapse on patient survival after cobalt 60 plaque radiotherapy.
        Ophthalmology. 1991; 98: 984-988
        • Caujolle J.P.
        • Paoli V.
        • Chamorey E.
        • et al.
        Local recurrence after uveal melanoma proton beam therapy: recurrence types and prognostic consequences.
        Int J Radiat Oncol Biol Phys. 2013; 85: 1218-1224
        • Vicente N.
        • Saornil M.A.
        • García-Álvarez C.
        • et al.
        Uveal melanoma: clinical characteristics, treatment and survival in a series of 500 patients.
        Arch Soc Esp Oftalmol. 2013; 88: 433-438
        • García-Álvarez C.
        • Saornil M.A.
        • López-Lara F.
        • et al.
        Episcleral brachytherapy for uveal melanoma: analysis of 136 cases.
        Clin Transl Oncol. 2012; 14: 350-355
      1. Uveal malignant melanoma: COMS results.
        in: Singh A.D. Damato B.E. Perer J. Clinical Ophthalmic Oncology. Saunders Elsevier, Philadelphia2007: 268
        • Kujala E.
        • Kivela T.
        Tumor, node, metastasis classification of malignant ciliary body and choroidal melanoma: evaluation of the 6th edition and future directions.
        Ophthalmology. 2005; 112: 1135-1144
      2. Edge S.E. Byrd D.R. Compton C.C. AJCC Cancer Staging Manual. 7th ed. Springer, New York2010
        • Nag S.
        • Quivey J.M.
        • Earle J.D.
        • et al.
        The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas.
        Int J Radiat Oncol Biol Phys. 2003; 56: 544-555
        • ABS-OOTF Committee
        The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma.
        Brachytherapy. 2014; 13: 1-14
        • Garcia-Arumi J.
        • Boixadera A.
        • Caminal J.M.
        • et al.
        Lesiones pigmentadas del fondo de ojo.
        Santiago de Compostela: Sociedad Española de Retina y Vítreo. 2012; : 53-60
        • Rivard M.J.
        • DeWerd L.
        • Coursey B.M.
        • et al.
        Update of AAPM Task Group No. 43 Report: a revised AAPM protocol for brachytherapy dose calculations.
        Med Phys. 2004; 31: 633-674
        • Tabandeh H.
        • Chaudhry N.A.
        • Murray T.G.
        • et al.
        Intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma.
        Am J Ophthalmol. 2000; 129: 199-204
        • Quivey J.M.
        • Char D.H.
        • Phillips T.L.
        • et al.
        High intensity 125-iodine (125I) plaque treatment of uveal melanoma.
        Int J Radiat Oncol Biol Phys. 1993; 26: 613-618
        • Sagoo M.S.
        • Shields C.L.
        • Mashayekhi A.
        • et al.
        Plaque radiotherapy for juxtapapillary choroidal melanoma: tumor control in 650 consecutive cases.
        Ophthalmology. 2011; 118: 402-407
        • Damato B.
        • Patel I.
        • Campbell I.R.
        • et al.
        Local tumor control after 106Ru brachytherapy of choroidal melanoma.
        Int J Radiat Oncol Biol Phys. 2005; 63: 385-391
        • Verschueren K.M.
        • Creutzberg C.L.
        • Schalij-Delfos N.E.
        • et al.
        Long-term outcomes of eye-conserving treatment with Ruthenium(106) brachytherapy for choroidal melanoma.
        Radiother Oncol. 2010; 95: 332-338
        • Rouberol F.
        • Roy P.
        • Kodjikian L.
        • et al.
        Survival, anatomic, and functional long-term results in choroidal and ciliary body melanoma after ruthenium brachytherapy (15 years' experience with beta-rays).
        Am J Ophthalmol. 2004; 137: 893-900
        • Char D.H.
        • Kroll S.
        • Phillips T.L.
        • et al.
        Late radiation failures after iodine 25 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy.
        Ophthalmology. 2002; 109: 1850-1854
        • Ocular Oncology Task Force
        Local recurrence significantly increases the risk of metastatic uveal melanoma.
        Ophthalmology. 2016; 123: 86-91
        • Folberg R.
        • Rummelt V.
        • Parys-Van Ginderdeuren R.
        • et al.
        The prognostic value of tumor blood vessel morphology in primary uveal melanoma.
        Ophthalmology. 1993; 100: 1389-1398
        • Foss A.J.
        • Alexander R.A.
        • Jefferies L.W.
        • et al.
        Microvessel count predicts survival in uveal melanoma.
        Cancer Res. 1996; 56: 2900-2903
        • Mäkitie T.
        • Summanen P.
        • Tarkkanen A.
        • Kivelä T.
        Microvascular loops and networks as prognostic indicators in choroidal and ciliary body melanomas.
        J Natl Cancer Inst. 1999; 91: 359-367
        • Mäkitie T.
        • Summanen P.
        • Tarkkanen A.
        • Kivelä T.
        Microvascular density in predicting survival of patients with choroidal and ciliary body melanoma.
        Invest Ophthalmol Vis Sci. 1999; 40: 2471-2480
        • Al-Jamal R.T.
        • Mäkitie T.
        • Kivelä T.
        Nucleolar diameter and microvascular factors as independent predictors of mortality from malignant melanoma of the choroid and ciliary body.
        Invest Ophthalmol Vis Sci. 2003; 44: 2381-2389
        • Damato B.
        • Eleuteri A.
        • Taktak A.F.
        • Coupland S.E.
        Estimating prognosis for survival after treatment of choroidal melanoma.
        Prog Retin Eye Res. 2011; 30: 285-295
        • Onken M.D.
        • Worley L.A.
        • Ehlers J.P.
        • Harbour J.W.
        Gene expression profiling in uveal melanoma reveals two molecular classes and predicts metastatic death.
        Cancer Res. 2004; 64: 7205-7209
        • Onken M.D.
        • Worley L.A.
        • Tuscan M.D.
        • Harbour J.W.
        An accurate, clinically feasible multi-gene expression assay for predicting metastasis in uveal melanoma.
        J Mol Diagn. 2010; 12: 461-468
        • Kivelä T.
        • Kujala E.
        Prognostication in eye cancer: the latest tumor, node, metastasis classification and beyond.
        Eye (Lond). 2013; 27: 243-252
        • Harbour J.W.
        • Chao D.L.
        A molecular revolution in uveal melanoma: implications for patient care and targeted therapy.
        Ophthalmology. 2014; 121: 1281-1288