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Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: Tumor control and treatment complications in 270 consecutive patients

Publication ,  Journal Article
Shields, CL; Cater, J; Shields, JA; Chao, A; Krema, H; Materin, M; Brady, LW
Published in: Archives of Ophthalmology
January 1, 2002

Objective: To evaluate tumor control and treatment complications following plaque radiotherapy combined with transpupillary thermotherapy for choroidal melanoma. Design: Prospective noncomparative interventional case series. Intervention: All patients received treatment for choroidal melanoma using plaque radiotherapy followed by 3 sessions of transpupillary thermotherapy provided at plaque removal and at 4-month intervals. Participants: Two hundred seventy patients with newly diagnosed choroidal melanoma. Main Outcome Measures: The 2 main outcome measures included local tumor recurrence and treatment-related complications. The clinical data regarding patient features, tumor features, radiotherapy and thermotherapy parameters were analyzed for their effect on the 2 main outcomes using Cox proportional hazards regression models. Results: Prior to treatment, the median base of the tumor was 11 mm (range, 4-21 mm) and the median thickness was 4 mm (range, 2-9 mm). Most tumors were located in the posterior pole with a median proximity of 2 mm to the foveola and 2 mm to the optic disc. The median radiotherapy dose to the tumor apex was 9000 rad. Transpupillary thermotherapy was applied in 3 sessions at 4-month intervals for a median of 700 mW. The tumor decreased in thickness to a median of 2.3 mm by 1 year and 2.1 mm by 2 years' follow-up with stable findings thereafter. Using Kaplan-Meier estimates, tumor recurrence was 2% at 2 years and 3% at 5 years. Risk factors for tumor recurrence included macular location of the tumor epicenter (P=.03), diffuse tumor configuration (P=.005), and tumor margin extending underneath the foveola (P=.001). Using Kaplan-Meier estimates, treatment- related complications at 5 years included maculopathy in 18% of the participants, papillopathy in 38%, macular retinal vascular obstruction in 18%, vitreous hemorrhage in 18%, rhegmatogenous retinal detachment in 2%, cataract in 6%, and neovascular glaucoma in 7%. Enucleation for radiation complications was necessary in 3 cases (1%). Conclusion: Plaque radiotherapy combined with transpupillary thermotherapy provides excellent local tumor control with only 3% recurrence at 5 years' follow-up.

Duke Scholars

Published In

Archives of Ophthalmology

DOI

ISSN

0003-9950

Publication Date

January 1, 2002

Volume

120

Issue

7

Start / End Page

933 / 940

Related Subject Headings

  • Ophthalmology & Optometry
  • 1113 Opthalmology and Optometry
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Shields, C. L., Cater, J., Shields, J. A., Chao, A., Krema, H., Materin, M., & Brady, L. W. (2002). Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: Tumor control and treatment complications in 270 consecutive patients. Archives of Ophthalmology, 120(7), 933–940. https://doi.org/10.1001/archopht.120.7.933
Shields, C. L., J. Cater, J. A. Shields, A. Chao, H. Krema, M. Materin, and L. W. Brady. “Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: Tumor control and treatment complications in 270 consecutive patients.” Archives of Ophthalmology 120, no. 7 (January 1, 2002): 933–40. https://doi.org/10.1001/archopht.120.7.933.
Shields CL, Cater J, Shields JA, Chao A, Krema H, Materin M, et al. Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: Tumor control and treatment complications in 270 consecutive patients. Archives of Ophthalmology. 2002 Jan 1;120(7):933–40.
Shields, C. L., et al. “Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: Tumor control and treatment complications in 270 consecutive patients.” Archives of Ophthalmology, vol. 120, no. 7, Jan. 2002, pp. 933–40. Scopus, doi:10.1001/archopht.120.7.933.
Shields CL, Cater J, Shields JA, Chao A, Krema H, Materin M, Brady LW. Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: Tumor control and treatment complications in 270 consecutive patients. Archives of Ophthalmology. 2002 Jan 1;120(7):933–940.

Published In

Archives of Ophthalmology

DOI

ISSN

0003-9950

Publication Date

January 1, 2002

Volume

120

Issue

7

Start / End Page

933 / 940

Related Subject Headings

  • Ophthalmology & Optometry
  • 1113 Opthalmology and Optometry