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Surgical Considerations of Radiation Plaques and Enucleation

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Uveal Melanoma
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Abstract

Since the Collaborative Ocular Melanoma Study (COMS) reported similar mortality rates between enucleation and plaque brachytherapy for patients with medium-sized choroidal melanoma, radiation plaques have become the standard method of treatment for uveal melanoma. However, enucleation remains a valid primary treatment technique in some cases of melanoma with specific surgical indications, risks, and benefits. Today, most physicians evaluate the size and location of the tumor, the presence of extrascleral extensions, feasibility of vision retention, and patient preference when deciding between surgical options, although controversy remains regarding the best treatment course for small- and large-sized tumors. In recent years, genetic profiling has also become an important factor in deciding metastatic risk in uveal melanoma, and fine needle aspiration biopsy is now an important step in assessing melanoma prognosis.

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References

  1. Augsburger JJ, et al. Fine needle aspiration biopsy in the diagnosis of intraocular cancer. Cytologic-histologic correlations. Ophthalmology. 1985;92(1):39–49. https://doi.org/10.1016/s0161-6420(85)34068-x.

    Article  CAS  PubMed  Google Scholar 

  2. Augsburger JJ, Shields JA. Fine needle aspiration biopsy of solid intraocular tumors. Trans Pa Acad Ophthalmol Otolaryngol. 1983;36(2):169–72.

    CAS  PubMed  Google Scholar 

  3. Augsburger JJ, Shields JA. Fine needle aspiration biopsy of solid intraocular tumors: indications, instrumentation and techniques. Ophthalmic Surg. 1984;15(1):34–40.

    CAS  PubMed  Google Scholar 

  4. Caminal JM, et al. Relative survival of patients with uveal melanoma managed in a single center. Melanoma Res. 2012;22(3):271–7. https://doi.org/10.1097/CMR.0b013e328353ef30.

    Article  PubMed  Google Scholar 

  5. Chalasani R, et al. Porous orbital implants in enucleation: a systematic review. Surv Ophthalmol. 2007;52(2):145–55. https://doi.org/10.1016/j.survophthal.2006.12.007.

    Article  PubMed  Google Scholar 

  6. Chappell MC, et al. Uveal melanoma: molecular pattern, clinical features, and radiation response. Am J Ophthalmol. 2012;154(2):227–232.e2. https://doi.org/10.1016/j.ajo.2012.02.022.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cho Y, et al. Ruthenium-106 Brachytherapy with or without additional local therapy shows favorable outcome for variable-sized choroidal melanomas in Korean patients. Cancer Res Treat. 2018;50(1):138–47. https://doi.org/10.4143/crt.2016.391.

    Article  CAS  PubMed  Google Scholar 

  8. Collaborative Ocular Melanoma Study (COMS) (n.d.). ClinicalTrials.gov. Available at: https://clinicaltrials.gov/ct2/show/NCT00000124 (Accessed: 29 September 2020).

  9. Collaborative Ocular Melanoma Study Group. Design and methods of a clinical trial for a rare condition: the collaborative ocular melanoma study. COMS report no. 3. Control Clin Trials. 1993;14(5):362–91. https://doi.org/10.1016/0197-2456(93)90052-f.

    Article  Google Scholar 

  10. Collaborative Ocular Melanoma Study Group. The collaborative ocular melanoma study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma II: initial mortality findings. COMS report no. 10. Am J Ophthalmol. 1998a;125(6):779–96. https://doi.org/10.1016/s0002-9394(98)00039-7.

    Article  Google Scholar 

  11. Collaborative Ocular Melanoma Study Group. The collaborative ocular melanoma study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma III: local complications and observations following enucleation COMS report no. 11. Am J Ophthalmol. 1998b;126(3):362–72. https://doi.org/10.1016/s0002-9394(98)00091-9.

    Article  Google Scholar 

  12. Collaborative Ocular Melanoma Study Group. Collaborative ocular melanoma study (COMS) randomized trial of I-125 brachytherapy for medium choroidal melanoma I. visual acuity after 3 years COMS report no. 16. Ophthalmology. 2001;108(2):348–66. https://doi.org/10.1016/S0161-6420(00)00526-1.

    Article  Google Scholar 

  13. Collaborative Ocular Melanoma Study Group. Trends in size and treatment of recently diagnosed choroidal melanoma, 1987–1997: findings from patients examined at collaborative ocular melanoma study (COMS) centers: COMS report no. 20. Arch Ophthalmol. 2003;121(8):1156–62. https://doi.org/10.1001/archopht.121.8.1156.

    Article  Google Scholar 

  14. COMS Plaques Menu (n.d.) EyePhysics. Available at: https://www.eyephysics.com/PS/PS6/UserGuide/COMSPlaquesMenu.html (Accessed: 30 September 2020).

  15. COMS Quality of LIfe Study Group. Quality of life assessment in the collaborative ocular melanoma study: design and methods. COMS-QOLS report no. 1. COMS quality of life study group. Ophthalmic Epidemiol. 1999;6(1):5–17. https://doi.org/10.1076/opep.6.1.5.1565.

    Article  Google Scholar 

  16. Damato B. Progress in the management of patients with uveal melanoma. The 2012 Ashton Lecture. Eye (Lond). 2012;26(9):1157–72. https://doi.org/10.1038/eye.2012.126.

    Article  CAS  Google Scholar 

  17. DecisionDx-UM Summary (n.d.) My Uveal Melanoma. Available at: https://www.myuvealmelanoma.com/health-care-professionals/decisiondx-um-summary/ (Accessed: 1 October 2020).

  18. Diener-West M, et al. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings. COMS Report No. 18. Arch Ophthalmol. 2001;119(7):969–82. https://doi.org/10.1001/archopht.119.7.969.

    Article  CAS  PubMed  Google Scholar 

  19. Eskelin S, et al. Tumor doubling times in metastatic malignant melanoma of the uvea: tumor progression before and after treatment. Ophthalmology. 2000;107(8):1443–9. https://doi.org/10.1016/s0161-6420(00)00182-2.

    Article  CAS  PubMed  Google Scholar 

  20. Eye Physics Plaques (n.d.) EyePhysics. Available at: https://www.eyephysics.com/EP/EPPlaques.html (Accessed: 30 September 2020).

  21. Field MG, Durante MA, et al. Epigenetic reprogramming and aberrant expression of PRAME are associated with increased metastatic risk in class 1 and class 2 uveal melanomas. Oncotarget. 2016a;7(37):59209–19. https://doi.org/10.18632/oncotarget.10962.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Field MG, Decatur CL, et al. PRAME as an independent biomarker for metastasis in uveal melanoma. Clin Cancer Res. 2016b;22(5):1234–42. https://doi.org/10.1158/1078-0432.CCR-15-2071.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Field MG, Harbour JW. Recent developments in prognostic and predictive testing in uveal melanoma. Curr Opin Ophthalmol. 2014;25(3):234–9. https://doi.org/10.1097/ICU.0000000000000051.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Finger PT, Moshfeghi DM, Ho TK. Palladium 103 ophthalmic plaque radiotherapy. Arch Ophthalmol. 1991;109(11):1610–3. https://doi.org/10.1001/archopht.1991.01080110148053.

    Article  CAS  PubMed  Google Scholar 

  25. Harbour JW, Chen R. The DecisionDx-UM gene expression profile test provides risk stratification and individualized patient care in uveal melanoma. PLoS Curr. 2013;5 https://doi.org/10.1371/currents.eogt.af8ba80fc776c8f1ce8f5dc485d4a618.

  26. Hawkins, B. S. and Collaborative Ocular Melanoma Study Group. The collaborative ocular melanoma study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma: IV. Ten-year mortality findings and prognostic factors. COMS report number 24. Am J Ophthalmol. 2004;138(6):936–51. https://doi.org/10.1016/j.ajo.2004.07.006.

    Article  Google Scholar 

  27. Honavar SG. Is collaborative ocular melanoma study (COMS) still relevant? Indian J Ophthalmol. 2018;66(10):1385–7. https://doi.org/10.4103/ijo.IJO_1588_18.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jampol LM, 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 no. 19. Ophthalmology. 2002;109(12):2197–206. https://doi.org/10.1016/s0161-6420(02)01277-0.

    Article  PubMed  Google Scholar 

  29. Jordan DR. Porous versus nonporous orbital implants: a 25-year retrospective. Ophthalmology. 2018;125(9):1317–9. https://doi.org/10.1016/j.ophtha.2018.03.055.

    Article  PubMed  Google Scholar 

  30. Karslıoğlu S, et al. Long-term outcomes of pegged and unpegged bioceramic orbital implants. Ophthal Plast Reconstr Surg. 2012;28(4):264–7. https://doi.org/10.1097/IOP.0b013e3182541315.

    Article  PubMed  Google Scholar 

  31. Melia M, et al. Quality of life after iodine 125 brachytherapy vs enucleation for choroidal melanoma: 5-year results from the Collaborative Ocular Melanoma Study: COMS QOLS Report No. 3. Arch Ophthalmol. 2006;124(2):226–38. https://doi.org/10.1001/archopht.124.2.226.

    Article  PubMed  Google Scholar 

  32. Moore RF. Choroidal sarcoma treated by the intraocular insertion of radon seeds. Br J Ophthalmol. 1930;14(4):145–52. https://doi.org/10.1136/bjo.14.4.145.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Onken MD, et al. Gene expression profiling in uveal melanoma reveals two molecular classes and predicts metastatic death. Cancer Res. 2004;64(20):7205–9. https://doi.org/10.1158/0008-5472.CAN-04-1750.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Onken MD, et al. An accurate, clinically feasible multi-gene expression assay for predicting metastasis in uveal melanoma. J Mol Diagn. 2010;12(4):461–8. https://doi.org/10.2353/jmoldx.2010.090220.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Onken MD, et al. Collaborative ocular oncology group report number 1: prospective validation of a multi-gene prognostic assay in uveal melanoma. Ophthalmology. 2012;119(8):1596–603. https://doi.org/10.1016/j.ophtha.2012.02.017.

    Article  PubMed  Google Scholar 

  36. Packer S. Iodine-125 radiation of posterior uveal melanoma. Ophthalmology. 1987;94(12):1621–6. https://doi.org/10.1016/s0161-6420(87)33241-5.

    Article  CAS  PubMed  Google Scholar 

  37. Pe’er J. Ruthenium-106 brachytherapy. Dev Ophthalmol. 2012;49:27–40. https://doi.org/10.1159/000328254.

    Article  PubMed  Google Scholar 

  38. Plaque Models (n.d.) EyePhysics. Available at: https://www.eyephysics.com/PS/PS6/UserGuide/PlaqueModels.html (Accessed: 30 September 2020).

  39. Plaque Simulator (n.d.) EyePhysics. Available at: https://www.eyephysics.com/PS/Index.html (Accessed: 30 September 2020).

  40. Puusaari I, et al. Iodine brachytherapy as an alternative to enucleation for large uveal melanomas. Ophthalmology. 2003;110(11):2223–34. https://doi.org/10.1016/S0161-6420(03)00661-4.

    Article  PubMed  Google Scholar 

  41. Shields CL, et al. Plaque radiotherapy for large posterior uveal melanomas (> or =8-mm thick) in 354 consecutive patients. Ophthalmology. 2002;109(10):1838–49. https://doi.org/10.1016/s0161-6420(02)01181-8.

    Article  PubMed  Google Scholar 

  42. Shields JA, Shields CL. Management of posterior uveal melanoma: past, present, and future: the 2014 Charles L. Schepens lecture. Ophthalmology. 2015;122(2):414–28. https://doi.org/10.1016/j.ophtha.2014.08.046.

    Article  PubMed  Google Scholar 

  43. Stallard HB. Radiotherapy for malignant melanoma of the choroid. Br J Ophthalmol. 1966;50(3):147–55. https://doi.org/10.1136/bjo.50.3.147.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. The Collaborative Ocular Melanoma Study Group. Factors predictive of growth and treatment of small choroidal melanoma: COMS Report No. 5. Arch Ophthalmol. 1997a;115(12):1537–44. https://doi.org/10.1001/archopht.1997.01100160707007.

    Article  Google Scholar 

  45. The Collaborative Ocular Melanoma Study Group. Mortality in patients with small choroidal melanoma. COMS report no. 4. Arch Ophthalmol. 1997b;115(7):886–93.

    Article  Google Scholar 

  46. Wladis EJ, et al. Orbital implants in enucleation surgery: a report by the American Academy of Ophthalmology. Ophthalmology. 2018;125(2):311–7. https://doi.org/10.1016/j.ophtha.2017.08.006.

    Article  PubMed  Google Scholar 

  47. Yang J, et al. Treatment of uveal melanoma: where are we now? Therap Adv Med Oncol. 2018;10:1758834018757175. https://doi.org/10.1177/1758834018757175.

    Article  Google Scholar 

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Correspondence to Amy C. Schefler .

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Schefler, A.C., Yu, H.J. (2021). Surgical Considerations of Radiation Plaques and Enucleation. In: Bernicker, E.H. (eds) Uveal Melanoma. Springer, Cham. https://doi.org/10.1007/978-3-030-78117-0_7

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  • DOI: https://doi.org/10.1007/978-3-030-78117-0_7

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