Survival following enucleation versus plaque radiotherapy in statisticallymatched subgroups of patients with choroidal melanomas: results in patients treated between 1980 and 1987

Background: The relative effectiveness of plaque radiotherapy and enucleati on in patients with choroidal or ciliochoroidal melanoma remains controvers ial. Most published comparative survival studies have evaluated clearly bia sed groups, short-term follow-up, or both. Methods: The authors performed a retrospective, non-randomized, comparative survival study on 734 patients with a choroidal or ciliochoroidal melanoma treated by enucleation (n=237) or plaque radiotherapy (n=497) between July 1980 and June 1985, and on a re sidual group of 448 patients, 103 treated by enucleation and 345 treated by plaque radiotherapy, identified by variable-by-variable range matching. Me lanoma-specific mortality and all-cause mortality were evaluated by the lif e-table method. Results: The melanoma-specific mortality rate was substanti ally worse in the original enucleation subgroup throughout available post-t reatment follow-up; however, differences in baseline prognostic factors bet ween the subgroups are likely to explain much of the survival differential. After eliminating patients with nonoverlapping values of individual clinic al variables to adjust for recognized intergroup differences at baseline, t here was no significant difference in the mortality curves of the residual subgroups. The cumulative 15-year survival based on deaths from metastatic melanoma in the enucleation subgroup was 57.1% (standard error=6.4%), while that in the plaque radiotherapy subgroup was 61.8% (standard error=3.3%). Conclusion: On the basis of these results, we conclude that a large differe nce in survival between equivalent groups of patients with primary choroida l or ciliary body melanoma treated by enucleation or by plaque radiotherapy appears unlikely.