Predictors of Outcomes in Iodine-125 Brachytherapy-Treated Uveal Melanomas: A Modern Institutional Study

A. Gurayah, V. A. Peters, D. Kwon, W. Zhao, W. Jin, N. V. Patel, A. M. Markoe, Z. Correa, M. T. Studenski, J. W. Harbour, S. Samuels

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE/OBJECTIVE(S): Plaque brachytherapy is an effective vision- and eye-sparing procedure for uveal melanoma. Few have investigated longitudinal tumor outcomes while using advanced dosimetry and plaque planning software. We hypothesize that patients with large tumors, pre-operative eye complications, and molecular class 2 tumors will have worse outcomes. MATERIALS/METHODS: We constructed an IRB-approved retrospective database from a single academic institution with uveal melanoma patients receiving Iodine-125 brachytherapy, 85 Gy over 72 hours prescribed to the tumor apex, between 2011-2019 with a minimum of 3-month follow-up. Data on patient demographics, tumor characteristics, pre-treatment (pre-Tx) retinal complications, post-plaque treatments (PPTx), local recurrences (LR), distant metastases (DM) and overall survival (OS) were collected. Univariate (UVA) and multivariate (MVA) Cox models for OS and cumulative incidence of LR/DM and death without LR/DM as competing risk were conducted using SAS version 9.4. Hazard ratios (HRs) and corresponding P-values were estimated. RESULTS: 262 patients were identified, with a median follow-up time of 33.5 months (3.02 - 97.3 months). 19 patients (7.3%) had local recurrence, 17 patients (6.5%) had distant metastasis, and 20 patients (7.6%) died. For LR, on UVA pre-Tx ocular melanocytosis (HR = 5.48, P = 0.01), Eye Physics plaque (HR = 3.70, P = 0.013), and PPTx with transpupillary thermotherapy (HR = 4.65, P = 0.002) were associated with increased LR. No association was found between class 2 tumors and LR (HR = 0.51, P = 0.297). For DM, on UVA pre-Tx retinal detachment (HR = 7.26, P = 0.002), class 2 tumors (HR = 4.35, P = 0.005), PPTx with intravitreal triamcinolone (HR = 4.01, P = 0.006), and large tumor height (HR = 1.23, P < 0.001), tumor area (HR = 1.02, P < 0.001), distance to fovea (HR = 1.13, P = 0.002), and prescription depth (HR = 1.23, P = 0.001) were all associated with increased DM. No MVA was conducted for LR and DM because there were too few events. For any tumor progression (LR or DM), on UVA pre-Tx ocular melanocytosis (HR = 4.26, P = 0.005), Eye Physics plaque (HR = 3.41, P = 0.002), any PPTx (HR = 4.50, P = 0.012), PPTx with intravitreal triamcinolone (HR = 3.30; P < 0.01), and large tumor area (HR = 1.01, P < 0.001) were associated with progression. On MVA pre-Tx ocular melanocytosis (HR = 5.55, P < 0.001), Eye Physics plaque (HR = 2.45, P = 0.049), and any PPTx (HR = 4.47, P = 0.017) were associated with progression. PPTx with aflibercept was associated with less progression (HR = 0.13, P = 0.019). CONCLUSION: Ocular melanocytosis and receiving any post-plaque treatment had the greatest impact on tumor progression. Class 2 tumors predicted for distant metastases but not local recurrences. These findings inform physicians of predictors of brachytherapy outcomes and allows for better shared-decision making with pre-operative patients. Future studies must validate these findings using a prospective cohort study.

Original languageEnglish (US)
Pages (from-to)e395
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume111
Issue number3
DOIs
StatePublished - Nov 1 2021

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Fingerprint

Dive into the research topics of 'Predictors of Outcomes in Iodine-125 Brachytherapy-Treated Uveal Melanomas: A Modern Institutional Study'. Together they form a unique fingerprint.

Cite this