PLAQUE RADIOTHERAPY FOR JUXTAPAPILLARY CHOROIDAL MELANOMA - VISUAL-ACUITY AND SURVIVAL OUTCOME

Objectives: To assess the effect of plaque radiotherapy on the visual acuity of patients with juxtapapillary choroidal melanoma and to deter mine the clinical predictive factors for radiation retinopathy, radiat ion papillopathy, local tumor recurrence, and distant metastasis. Desi gn: A retrospective review of the medical records of 93 patients with juxtapapillary choroidal melanoma who were treated initially with plaq ue radiotherapy. Results: During a mean follow-up of 78 months, radiat ion retinopathy developed in 81 patients (87%) and radiation papillopa thy developed in 48 patients (52%) after a mean interval of 21 and 27 months, respectively. The univariate variables that were significant p redictors of radiation retinopathy were history of diabetes mellitus ( P=.05) and use of a notched radioactive plaque (P=.04). The factors pr edictive of radiation papillopathy were age (>45 years; P=.01), histor y of diabetes mellitus (P=.05), mushroom-shaped tumor configuration (P =.006), and nasal location of the tumor (P=.04). By using Kaplan-Meier survival curves, we found that the proportion of the 93 patients with radiation retinopathy was 87 (94%) at 5 years and with radiation papi llopathy was 53 (57%) at 5 years. By using life-table analysis, we fou nd that the proportion of the 93 patients who experienced a decrement of at least 3 lines of visual acuity was 67 (72%) by 50 to 60 months. Local tumor recurrence was documented in 14 patients (15%) after a mea n interval of 41 months. The age of the patient (<35 years; P=.02) and the superior (P=.004) and inferior (P=.05) locations of the tumor wer e predictive of local tumor recurrence. Distant metastasis developed i n 11 patients (12%) after a mean interval of 44 months. The factors pr edictive of distant metastasis were a tumor with a basal diameter larg er than 6.0 mm (P=.05), the superior location of the tumor (P=.01), an d local tumor recurrence (P<.001). Conclusion: Based on these observat ions, plaque radiotherapy remains a potential option vs enucleation fo r the management of juxtapapillary choroidal melanoma.