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

4/2020
vol. 12
 
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abstract:
Original paper

Eye plaque brachytherapy versus enucleation for ocular melanoma: an analysis from the National Cancer Database

Jay A. Messer
1, 2
,
Raed J. Zuhour
1, 2
,
Waqar Haque
2
,
Gary D. Lewis
3
,
Amy C. Schefler
4
,
Andrew Wong
1, 2
,
Eric H. Bernicker
5
,
Patricia Chevez-Barrios
6
,
Enzhuo Michelle Quan
2
,
Andrew Farach
2
,
E. Brian Butler
2
,
Sandra S. Hatch
1, 7
,
Bin S. Teh
2

1.
Department of Radiation Oncology, The University of Texas Medical Branch, Galveston, TX, USA
2.
Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
3.
Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
4.
Department of Ophthalmology, Houston Methodist Hospital, Houston, TX, USA
5.
Department of Medical Oncology, Houston Methodist Hospital, Houston, TX, USA,
6.
Department of Pathology, Houston Methodist Hospital, Houston, TX, USA
7.
Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
J Contemp Brachytherapy 2020; 12, 4: 303–310
Online publish date: 2020/08/21
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Purpose
There is no current randomized data comparing the efficacy of brachytherapy and enucleation for patients with larger sized tumors. The purpose of the present study was to use a large, contemporary database to determine current practice patterns and compare survival outcomes between different management options for patients with choroidal melanoma of various sizes.

Material and methods
The National Cancer Database was queried (2004-2014) for histologically-confirmed choroidal melanoma for patients treated with brachytherapy versus enucleation. Chi-square test was used to compare categorized demographic and clinical variables in both arms. Kaplan-Meier analysis evaluated overall survival (OS). Cox proportional hazards assessment determined variables associated with OS. Patients were divided into cohorts representing small, medium, and large tumors. Propensity scores matching (PSM) was utilized to compare more similar cohorts.

Results
A total of 7,096 patients met the selection criteria; 5,501 (78%) patients received brachytherapy and 1,595 (22%) patients were treated with enucleation. After PSM, 5-yr OS for small tumors was 87% vs. 64%, for medium tumors was 77% vs. 57%, and for large tumors was 68% vs. 46% for brachytherapy and enucleation, respectively (p < 0.001). Following PSM, multivariate Cox regression found older age (hazard ratio [HR] = 1.76, 95% confidence interval [CI] = 1.51-2.06), more comorbidities (HR = 1.46, 95% CI = 1.25-1.70), extraocular extension (EOE) (HR = 1.25, 95% CI = 1.06-1.48), ciliary body invasion (CBI) (HR = 1.20, 95% CI = 1.02-1.40), and larger size (HR = 1.52, 95% CI = 1.40-1.66) were negative prognosticators of survival. Brachytherapy was a positive prognosticator of survival (HR = 0.45, 95% CI = 0.40-0.51).

Conclusions
Patients selected for brachytherapy had improved survival compared to enucleation in all size cohorts. EOE and CBI are significantly higher in the enucleation cohort and are important negative prognosticators for survival selected against patients having brachytherapy. Brachytherapy is a reasonable treatment option for certain patients with large size tumors.

keywords:

ocular melanoma, eye plaque brachytherapy, enucleation, NCDB, National Cancer Database, large tumors

 
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