Oftalmol Zh.2010;5:46-55.



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.



1.Бровкина А. Ф. Современные аспекты лечения меланом хориоидеи: проблемы, дискуссионные вопросы // Вестн. офтальмол. — 2006. — № 1. — С. 13 — 16.

2.Бровкина А.Ф, Вальский В. В. , Гусев Г. А. и др. Риск метастазирования меланом хориоидеи после брахитерапии // Вестн. офтальмол. — 2003. — № 2. — С. 26 — 28.

3.Вит В.В, Буйко А.С, Драгомирецкая Е. И. Оценка степени злокачественности увеальной меланомы на основе использования кластерного анализа // Офтальмол. журн. — 2004. — № 6. — С. 18 — 23.

4.Вит В. В. Патологическая анатомия и лечебный патоморфоз пигментных новообразований увеального тракта глаза // Диссерт. ...д-ра мед. наук. — Одесса, 1986. — 406 с.

5.Терентьева Л.С, Вит В. В. Полякова С. И. Прогностическое зачение фактора вторичной глаукомы при органосохранном лечении увеальной меланомы // Офтальмол. журн. — 2004. — № 6. — С. 8 — 12.

6.Almony A, Breit S, Zhao H et al. Tilting of radioactive plaques after initial accurate placement for treatment of uveal melanoma // Arch Ophthalmol 2008; 126(1):65- 70.

7.Augsburger JJ, Lauritzen K, Gamel JW et al. Matched group study of preenucleation radiotherapy versus enucleation alone for primary malignant melanoma ofthe choroid and ciliary body // Am J Clin Oncol. 1990; 13:382- 387.

8.Augsburger JJ, Schneider S, Freire J, Brady LW. Survival following enucleation versus plaque radiotherapy in statistically matched subgroups of patients with choroidal mela-nomas: results in patients treated between 1980 and 1987 // Graefe's Arch Clin Exp Ophthalmol 1999;237:558- 67.

9.Bechrakis NE, Sehu KW, Lee WR Transformation of Cell Type in Uveal Melanomas // Arch Ophthalmol.2000;118:1406-1412

10.Bechrakis N, Lakotka N, Alekian L et al. Langzeitergebnisse nach Ruthenium-106 Brachytherapie // Spektrum der Augenheilkunde 2009:23/2;85

11.Bergman L, Nilsson B, Lundell G et al. Ruthenium Brachytherapy for Uveal Melanoma, 1979- 2003 // Ophthalmology 2005;112:834-840

12.Char DH, Kroll S, Quivey JM, Castro J. Long term visual outcome of radiated uveal melanomas in eyes eligible for randomisation to enucleation versus brachytherapy // Br J Ophthalmol 1996;80:117- 124.

13.Char DH, Miller T, Crawford JB. Analysis of melanoma cell type in uveal melanoma following treatment failure //Am J Ophthalmol. 2004;138(4):543-546.

14.Chabert S, Velikay-Parel M and Zehetmayer M. Influence of uveal melanoma therapy on patients quality of life: a psycho-logical study // Acta Ophthalmol. Scand. 2004:82:25- 31

15.COMS Randomized Trial of Iodine 125 Brachytherapy for Choroidal Melanoma V. Twelve-Year Mortality Rates and Prognostic Factors: COMS Report No. 28 // Arch Oph-thalmol. 2006;124:1684- 1693.

16.COMS Report No. 6. Histopathologic Characteristics of Uveal Melanomas in Eyes Enucleated From the Collaborative Ocular Melanoma // Am J Ophthalmol 1998; 125:745- 766.

17.COMS Report No. 3 Quality of Life After Iodine 125 Brachytherapy vs Enucleation for Choroidal Melanoma. 5-Year Results From the Collaborative Ocular Melanoma Study // Arch Ophthalmol. 2006;124:226- 238.

18.Egger E, Schalenbourg A, Zografos L et al. Maximizing Local Tumor Control and Survival after Proton Beam Radiotherapy of Uveal Melanoma // Int. J. Radiation Oncol¬ogy Biol. Phys. 2001;51/1:138- 147.

19.van Ginderdeuren R, van Limbergen E, Spileers W. 18 Years' experience with high dose rate strontium-90 brachytherapy of small to medium sized posterior uveal melanoma // Br J

Ophthalmol 2005;89:1306-1310.

20.Gragoudas E; Li W, Goitein M. Evidence-Based Estimates of Outcome in Patients Irradiated for Intraocular Melanoma // Arch Ophthalmol. 2002;120:1665- 1671

21.Hadden PW, Hiscott PS, Damato BE. Histopathology of eyes enucleated after endoresection of choroidal melanoma // Ophthalmology 2004;111:154- 160.

22.Jampol LM, Moy CS, Murray TO, et al. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: IV. Local treatment failure and enucleation in the first 5 years after brachytherapy // COMS report no19 Ophthalmology 2002;109:2197- 2206.

23.Kilic E, Stijnen T, de Long PTVM. Reduced Melanoma-Related Mortality in Uveal Melanoma by Preenucleation Radiotherapy // Arch Ophthalmol. 2005;123:1363- 1367

24.Kivela T. Uveal malignant melanoma: histopathologic features. In: Clinical Ophthalmic Oncology Published by Saunders Elsevier, 2007, Philadelphia, pp 219-25.

25.Lommatzsch PK, Werschnik C, Schuster E. Long-term follow-up of Ru-106/Rh-106 brachytherapy for posterior uveal melanoma // Graefe's Arch Clin Exp Ophthalmol 2000; 238:129- 137.

26.Manschot WA, Lee WR, van Strik R Uveal melanoma: updated considerations on current management modalities // Int Ophthalmol 1996;19:203- 209

27.McLean JW, Burnnie MN, Zimmerman LE. Tumors of the Eye and Ocular Adnexa. Washington, 1994; D.C AFIP: p322.

28.Missotten L, Dirven W, Van der Schueren A. Results of treatment of choroidal malignant melanoma with highdoserate strontium-90 brachytherapy // Graefe's Arch Clin Exp Ophthalmol 1998; 236:164- 173.

29.De Potter P, Shields CL, Shields JA. Impact of enucleation versus plaque radiotherapy in the management of juxtapapillary choroidal melanoma on patient survival // Br J Ophthalmol. 1994,78:109- 114.

30.Sagoo MS, Shields Carol L, Mashayekhi A. Plaque Ra-diotherapy for Choroidal Melanoma Encircling the Optic Disc (Circumpapillary Choroidal Melanoma) // Arch Ophthalmol. 2007;125(9):1202- 1209.

31.Seddon JM, Gragoudas ES, Albert DM. Comparison of survival rates for patients with uveal melanoma after treatment with proton beam irradiation or enucleation // Am J Ophthalmol 1995; 99: 282- 90.

32.Seddon JM, Gragoudas ES, Egan KM. Relative Survival Rates after Alternative Therapies for Uveal Melanoma // Ophthalmology 1990; 97:769- 777.

33.Seregard S. Long-term survival after ruthenium plaque radiotherapy for uveal melanoma. A meta-analysis of studies including 1,066 patients // Acta Ophthalrrtol. Scand. 1999: 77: 414- 417

34.Shields CL, Furuta M, Thangappan A et al. Metastasis of uveal melanoma millimetre-by-millimeter in 8033 consecutive eyes // Arch Ophthalmol 2009;127(8):989- 98.

35.Shields CL, Bianciotto C, Rudich D. et al. Regression of uveal melanoma after plaque radiotherapy and thermotherapy based on chromosome 3 status // Retina 2008;14 (abstract).

36.Singh AD, Rennie IG, Kivela T et al. The Zimmerman-McLean-Foster hypothesis: 25 years later // Br J Ophthalmol 2004;88:962-967.

37.Zimmerman US, McLean IW, Foster WD. Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumour cells // Br J Ophthalmol 1978; 62:420- 5.

38.Zehetmayer M, Dieckmann K, Bogner J et al. A linac-based stereotactic irradiation technique of uveal melanoma // Radiotherapy and Oncology 61 (2001) 49- 56.