Journal article
Scleral Necrosis after Plaque Radiotherapy of Uveal Melanoma: A Case-Control Study
Ophthalmology (Rochester, Minn.), v 120(5), pp 1004-1011
01 May 2013
PMID: 23347983
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Abstract
Purpose: To identify risk factors and outcome of scleral necrosis after plaque radiotherapy of uveal melanoma.
Design: Case-control study.
Participants: A total of 73 cases with scleral necrosis and 73 controls without necrosis after plaque radiotherapy. Controls were matched for anteroposterior tumor epicenter and follow-up duration.
Intervention: Plaque radiotherapy with iodine-125, cobalt-60, iridium-192, or ruthenium-106.
Main Outcome Measures: Scleral necrosis.
Results: Of 5057 patients treated with plaque radiotherapy for uveal melanoma, 73 (1%) developed radiotherapy-induced scleral necrosis. Scleral necrosis occurred in <1% of patients (3/1140) when plaque radiotherapy was used for tumors <3 mm in thickness, 1% of patients (33/3155) with 3- to 8-mm tumor thickness, and 5% of patients (37/762) with >8-mm-thick tumors. On the basis of tumor location, scleral necrosis was detected after plaque radiotherapy of iris melanoma in 0% of patients (0/91), ciliary body melanoma in 29% of patients (67/235), and choroid melanoma in <1% of patients (6/4731). The mean time interval between plaque radiotherapy and scleral necrosis was 32 months (median, 23 months; range, 4-126 months). The mean basal dimension of scleral necrosis was 4 mm (median, 3 mm; range, 1-15 mm), equivalent to 29% of mean tumor base (median, 24%; range, 6%-100%) and 22% of mean plaque size (median, 19%; range, 5%-75%). Multivariate analysis of factors that predicted clinically evident scleral necrosis included ciliary body (P = 0.0001) and pars plana to ora serrata (P < 0.0001) locations of anterior tumor margin, tumor thickness >= 6 mm (P = 0.0001), and radiation dose >= 400 Gy to the outer sclera (P = 0.0455). Scleral necrosis remained stable in 48% of patients (35/73), increased in size/severity in 48% of patients (35/73), or progressed to scleral perforation in 4% of patients (3/73) over a mean follow-up of 79 months (median, 54 months; range, 5-351 months). Treatment of scleral necrosis included observation in 81% of patients (59/73), scleral patch graft in 14% of patients (10/73), and enucleation in 5% of patients (4/73).
Conclusions: Scleral necrosis after plaque radiotherapy of uveal melanoma was detected in 1% of cases. Factors predictive of scleral necrosis included increasing tumor thickness, ciliary body and peripheral choroidal location, and higher radiation dose to sclera. Most patients (81%) did not require treatment, and 4% evolved to full-thickness perforation.
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Details
- Title
- Scleral Necrosis after Plaque Radiotherapy of Uveal Melanoma: A Case-Control Study
- Creators
- Swathi Kaliki - Wills Eye HospitalCarol L. Shields - Wills Eye HospitalDuangnate Rojanaporn - Ramathibodi HospitalJosep Badal - Wills Eye HospitalLaxmi Devisetty - Wills Eye HospitalJacqueline Emrich - Drexel UniversityLydia Komarnicky - Drexel UniversityJerry A. Shields - Wills Eye Hospital
- Publication Details
- Ophthalmology (Rochester, Minn.), v 120(5), pp 1004-1011
- Publisher
- Elsevier
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine); [Retired Faculty]
- Web of Science ID
- WOS:000318683400019
- Scopus ID
- 2-s2.0-84877745683
- Other Identifier
- 991019168229704721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Ophthalmology