PLAQUE RADIOTHERAPY FOR POSTERIOR UVEAL MELANOMA IN 4000 EYES: Analysis of ≥15-Letter Visual Acuity Loss in the Pre-anti-VEGF Era.

Abstract

To evaluate ≥15-letter visual acuity loss after plaque radiotherapy of posterior uveal melanoma (PUM) in the pre-anti-vascular endothelial growth factor era. We reviewed data on 4,000 consecutive patients managed between 1976 and 2008 regarding patient demographics, tumor features, treatment factors, and ≥15-letter visual acuity loss over time based on tumor size category of small (0-3.0 mm thickness), medium (3.1-8.0 mm), and large (>8.0 mm). Of the 4,000 patients, there were small (n = 1,011 eyes, 25%), medium (n = 2,445, 61%), and large (n = 544, 14%) tumor categories. The PUM touched the optic disc (n = 560, 14%) and/or extended under the foveola (n = 644, 16%). Comparative analysis (small vs. medium versus large PUM) showed small tumor category with demographics of younger age ( P < 0.01) and greater White race ( P < 0.05), presenting features of visual acuity ≥20/40 ( P < 0.01) and closer proximity to the optic disc ( P < 0.01) and foveola ( P < 0.01), and radiation treatment parameters most intense at the foveola ( P < 0.01). The median radiation dose to the optic disc (3,100 vs. 3,257 vs. 4,336 cGy, P < 0.01) and the foveola (3,964 vs. 3,864 vs. 4,598 cGy, P < 0.01) was noted. Overall, ≥15-letter loss was found in 62% patients at median 16 months. By Kaplan-Meier analysis of all cases, ≥15-letter loss at 1 versus 2 versus 3 versus 5 versus 10 years was present in 30% versus 48% versus 60% versus 73% versus 82%. In the pre-anti-vascular endothelial growth factor days, after treatment of PUM with plaque radiotherapy, visual acuity showed ≥15-letter loss in 62% of patients at median 16 months.