Radiation complications and tumor control after plaque radiotherapy of choroidal melanoma with macular involvement

PURPOSE: To determine the outcome of plaque radiotherapy in the treatment o f macular choroidal melanoma and to identify the risk factors associated wi th the development of radiation complications, tumor recurrence, and metast asis, METHODS: Chart analysis of 630 consecutive patients (630 eyes) with macular choroidal melanoma managed by plaque radiotherapy between July 1976 and Ju ne 1992, RESULTS: The median largest basal tumor diameter was 10 mm, and the median tumor thickness was 4 mm, By means of Kaplan-Meier estimates, visually sign ificant maculopathy developed at 5 years in 40% of the patients, cataract i n 32%, papillopathy in 13%, and tumor recurrence in 9%. Vision decrease by 3 or more Snellen lines was found in 40% of the patients at 5 years. Sixty nine eyes (11%) were enucleated because of radiation complications and recu rrence. Twelve percent of the patients developed metastasis by 5 years and 22% by 10 years. Results of multivariate Cox proportional hazards analyses showed that the s ignificant predictors for tumor recurrence were a distance of tumor margin from the optic disk of less than 2 mm (P = .003) and retinal invasion (P = .009). The significant variables that were predictive of metastasis include d tumor thickness greater than 4 mm (P = .02) and largest basal tumor diame ter greater than 10 mm (P = .03). CONCLUSIONS: Plaque radiotherapy offers a 91% 5-year local tumor control ra te for macular choroidal melanoma, Despite good local tumor control, the ri sk for metastasis is 12% at 5 years and 22% at 10 years. In 11% of the pati ents, enucleation eventually became necessary because of radiation complica tions and tumor recurrence. (C) 1999 by Elsevier Science Inc. All rights re served.