Journal article
Iris Melanoma Management with Iodine-125 Plaque Radiotherapy in 144 Patients: Impact of Melanoma-Related Glaucoma on Outcomes
Ophthalmology (Rochester, Minn.), v 120(1), pp 55-61
01 Jan 2013
PMID: 22980742
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose: To evaluate the outcomes of iris melanoma managed with plaque radiotherapy on the basis of the initial presence or absence of glaucoma.
Design: Retrospective, comparative case series.
Participants: A total of 144 patients.
Intervention: Custom-designed iodine-125 plaque radiotherapy delivering planned 8000 cGy to melanoma apex using transcorneal application.
Main Outcome Measures: Tumor control and treatment-related complications.
Results: Of 144 patients with iris melanoma, glaucoma was present at the initial visit in 58 (40%). Causes of elevated intraocular pressure included angle infiltration by melanoma in 50 patients (86%), angle neovascularization in 4 patients (7%), and hyphema in 4 patients (7%). At presentation, the eyes displaying iris melanoma with glaucoma (vs. without glaucoma) were statistically more likely to display angle tumor (66% vs. 43%), with minimal thickness (1.9 vs. 2.9 mm), and melanoma seeding in iris stroma (7 vs. 3 clock hours) and angle (5 vs. 2 clock hours). Plaque radiotherapy was performed in all cases. Kaplan-Meier estimates at 7 years post-treatment revealed no statistical differences in outcomes of local recurrence (14% vs. 15%), enucleation (14% vs. 11%), or metastasis (2% vs. 0%) comparing eyes with and without glaucoma. Of the entire group, multivariate analysis for factors predictive of recurrence included partial (vs. complete) anterior segment irradiation and post-radiotherapy glaucoma. Factors related to enucleation included diabetes mellitus, poor initial visual acuity, higher radiation dose to tumor apex, and tumor recurrence. There were no factors predictive of metastasis.
Conclusions: Iodine-125 plaque radiotherapy provides adequate tumor control for iris melanoma with a low metastatic potential of 1% at 7 years. Iris melanoma with secondary glaucoma showed a statistically significant greater likelihood of flat tumor with iris and angle seeding and no difference in outcomes compared with eyes without glaucoma.
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Details
- Title
- Iris Melanoma Management with Iodine-125 Plaque Radiotherapy in 144 Patients: Impact of Melanoma-Related Glaucoma on Outcomes
- Creators
- Carol L. Shields - Wills Eye HospitalSanket U. Shah - Wills Eye HospitalCarlos G. Bianciotto - Wills Eye HospitalJacqueline Emrich - Drexel UniversityLydia Komarnicky - Drexel UniversityJerry A. Shields - Wills Eye Hospital
- Publication Details
- Ophthalmology (Rochester, Minn.), v 120(1), pp 55-61
- Publisher
- Elsevier
- Number of pages
- 7
- Grant note
- Paul Kayser International Award of Merit in Retina Research, Houston, Texas Eye Tumor Research Foundation, Philadelphia, Pennsylvania Retina Research Foundation of the Retina Society
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine); [Retired Faculty]
- Web of Science ID
- WOS:000313011700010
- Scopus ID
- 2-s2.0-84872010295
- Other Identifier
- 991019169640004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Ophthalmology