eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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SCImago Journal & Country Rank

2/2022
vol. 14
 
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abstract:
Original paper

Contemporary trends in management of uveal melanoma

Neil Chevli
1
,
Raed J. Zuhour
1
,
Jay A. Messer
1
,
Waqar Haque
2
,
Amy C. Schefler
3
,
Eric H. Bernicker
4
,
Patricia Chevez-Barrios
5
,
Andrew M. Farach
2
,
E. Brian Butler
2
,
Bin S. Teh
2

1.
Department of Radiation Oncology, University of Texas Medical Branch at Galveston, Galveston, TX, USA,
2.
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA,
3.
Retina Consultants of Houston, Houston, TX, USA,
4.
Department of Medical Oncology, Houston Methodist Hospital, Houston, TX, USA,
5.
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
J Contemp Brachytherapy 2022; 14, 2: 123–129
Online publish date: 2022/04/02
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Introduction
In the management of uveal melanoma, eye plaque brachytherapy (EPBT) has replaced enucleation as the standard of care for small size tumors that require treatment, and for medium size tumors. In the modern era, EPBT is being utilized more frequently for certain large tumors as well. While there is prospective randomized evidence to support utilization of EPBT for tumors of appropriate dimensions, it is unclear what the actual practice patterns are across the United States. The purpose of this publication was to look at contemporary trends in the management of uveal melanoma across the United States to determine whether practices are appropriately adopting EPBT, and to investigate demographic and socio-economic factors that might be associated with deviations from this standard of care.

Material and methods
The National Cancer Database was queried (2004-2015) for patients with uveal melanoma. Data regarding tumor characteristics and treatment were collected. Two-sided Pearson χ2 test was used to compare categorical frequencies between patients who received globe preserving treatments vs. those who received enucleation. Multivariable logistic regression modeling was used to determine characteristics predictive for receiving enucleation.

Results
The enucleation rate for small/medium tumors (≤ 10 mm apical height and ≤ 16 mm basal diameter) decreased from 20% in 2004 to 10% in 2015. The EPBT rate for large tumors increased from 30% in 2004 to 45% in 2015. Numerous demographic and socio-economic factors were found to be associated with higher rates of enucleation.

Conclusions
The overall trend across the nation is a decreased enucleation rate for small/medium tumors, and an increased EPBT rate for large tumors. A fraction of patients who should be candidates for EPBT are instead receiving enucleation, and in this study, we have shown that certain adverse demographic factors are associated with this.

keywords:

eye plaque brachytherapy, uveal melanoma, enucleation

 
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