Jw. Harbour et al., METASTATIC RISK FOR DISTINCT PATTERNS OF POSTIRRADIATION LOCAL RECURRENCE OF POSTERIOR UVEAL MELANOMA, Ophthalmology, 104(11), 1997, pp. 1785-1792
Objective: The purpose of the study is to compare the prognostic signi
ficance of horizontal/marginal versus vertical/diffuse patterns of pos
tirradiation local recurrence of posterior uveal melanoma. Design: The
study design was a nonrandomized, retrospective clinical study. Semip
arametric and nonparametric statistical techniques were used. Particip
ants: Seven hundred sixty-six posterior uveal melanoma patients were s
tudied. Intervention: Either iodine-125 plaque or helium ion radiation
therapy was performed. Main Outcome Measures: Local tumor recurrence
and systemic metastasis were measured. Results: Local tumor recurrence
was detected in 66 (8.6%) of 766 irradiated tumors. The 5-year actuar
ial rate of local recurrence was 10%. The recurrence pattern was horiz
ontal/marginal in 27 patients (41%) and vertical/diffuse in 39 patient
s (59%). Systemic metastasis was detected in 5 patients (19%) with hor
izontal/marginal recurrence and in 19 patients (49%) with vertical/dif
fuse recurrence. After known metastatic risk factors were controlled,
the relative risk for metastasis was 2.2 for horizontal/marginal recur
rence and 5.1 for vertical/diffuse recurrence (P = 0.05). The actuaria
l rate of systemic metastasis was 2.9% per year for all patients, 6.3%
per year for patients with horizontal/marginal recurrence, and 15.5%
per year for patients with vertical/diffuse recurrence. Conclusions: P
ostirradiation local recurrence of posterior uveal melanoma is a risk
factor for systemic metastasis. Vertical/diffuse recurrences may be as
sociated more strongly with metastatic disease than horizontal/margina
l recurrences.