http://doi.org/10.31288/oftalmolzh201054655

SURVIVAL INDICES OF PATIENTS WITH UVEAL MELANOMA IN ITS TREATMENT WITH 90SR BRACHYTHERAPY + PHOTOCOAGULATION, RADIOTHERMOTHERAPY AND PRIMARY ENUCLEATION

A. S. Bouiko

Odessa, Ukraine

Aims— To determine the long term survival outcome of uveal melanomas (UM) patient's who were treated with either enucleation or radiothermotherapy, or 90Sr brachytherapy+xenon photocoagulation. Methods: The authors performed a retrospective non-randomized comparative survival study patients with a posterior choroidal melanoma (h=5.4±1.6 mm) treated by enucleation (n=282) vs 90Sr brachytherapy+ xenon photocoagulation (n=515) and or ciliochoroidal melanoma (h=9.1±2.6mm) treated by enucleation (174) vs radiothermotherapy (79) between 1970 and 2000, identified by variable-by-variable range matching. All-cause mortality is evaluated by the life-table and Kaplan-Meier methods. The survival curves of the groups were compared using the Log-Rank test. Results. The cumulative 5-and 10-year survival based on deaths from all-cause mortality posterior UM patients in the enucleation group was 0.82±0.03 and 0.69±0.03, while that in the 90Sr brachytherapy+xenon photocoagulation group was 0.87±0.02 and 0.67±0.04, respectively. The Kaplan-Meier survival rates at 5 and 10 years for enucleation group were 0.82±0.03 and 0.69±0.03, and for 90Sr brachytherapy+xenon photocoagulation group 0.87±0.02 and 0.67±0.04 respectively. The log-rank test indicated a p -value of p = 0.78. The cumulative 5-and 10-year survival based on deaths from all-cause mortality ciliochoroidal UM patients in the enucleation group was 0.76±0.06 and 0.46±0.09, while that in the radiothermotherapy group was 0.59±0.04 and 0.41±0.05, respectively. The Kaplan-Meier survival rates at 5 and 10 years for enucleation group were 0.76±0.06 and 0.46±0.09, and for radiothermotherapy group 0.59±0.04 and 0.41±0.05, respectively. The log-rank test indicated a p -value of p = 0.1. The survival rates were calculated for patients having their tumor controlled (131 from 515) after the first treatment 90Sr brachytherapy+xenon photocoagulation and patients with local tumor control failure (182 from 515). The Kaplan-Meier survival rates at 5 and 10 years for tumor controlled subgroup were 0.95±0.03 and 0.82±0.07, and for local tumor control failure group 0.82±0.03 0.51±0.08 respectively. The log-rank test indicated a p -value of p = 0.00. Conclusions. The all-cause UM melanoma mortality curves of patients with comparable choroidal and ciliochoroidal melanomas treated by 90Sr plaque radiation therapy+ photocoagulation and radiothermotherapy, respectively, versus enucleation are quite similar over the first 5 and 10 years ofpost-treatment follow-up. Our analysis supports that the rate of death by metastases is influenced by local tumor control failure.

 

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