Title

Evidence-based estimates of outcome in patients irradiated for intraocular melanoma

UMMS Affiliation

Department of Medicine, Division of Preventive and Behavioral Medicine

Date

12-10-2002

Document Type

Article

Subjects

Adolescent; Adult; Aged; Aged, 80 and over; Child; Eye Enucleation; Female; Follow-Up Studies; Humans; Likelihood Functions; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Risk Factors; Uveal Neoplasms; Visual Acuity

Disciplines

Ophthalmology

Abstract

BACKGROUND: Melanoma of the eye is the only potentially fatal ocular malignancy in adults. Until radiation therapy gained wide acceptance in the 1980s, enucleation was the standard treatment for the tumor. Long-term results after proton beam irradiation are now available.

METHODS: We developed risk score equations to estimate probabilities of the 4 principal treatment outcomes-local tumor recurrence, death from metastasis, retention of the treated eye, and vision loss-based on an analysis of 2069 patients treated with proton beam radiation for intraocular melanoma between July 10, 1975, and December 31, 1997. Median follow-up in surviving patients was 9.4 years.

RESULTS: Tumor regrowth occurred in 60 patients, and 95% of tumors (95% confidence interval, 93%-96%) were controlled locally at 15 years. Risk scores were developed for the other 3 outcomes studied. Overall, the treated eye was retained by 84% of patients (95% confidence interval, 80%-87%) at 15 years. The probabilities for vision loss (visual acuity worse than 20/200) ranged from 100% to 20% at 10 years and for death from tumor metastases from 95% to 35% at 15 years, depending on the risk group.

CONCLUSIONS: High-dose radiation treatment was highly effective in achieving local control of intraocular melanomas. In most cases, the eye was salvaged, and functional vision was retained in many patients. The mortality rate was high in an identifiable subset of patients who may benefit from adjuvant therapies directed at microscopic liver metastases.

Rights and Permissions

Citation: Gragoudas E, Li W, Goitein M, Lane AM, Munzenrider JE, Egan KM. Evidence-based estimates of outcome in patients irradiated for intraocular melanoma. Arch Ophthalmol. 2002 Dec;120(12):1665-71. doi:10.1001/archopht.120.12.1665

Comments

At the time of publication, Wenjun Li was not yet affiliated with the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID

12470140