Conservation of eyes with choroidal melanoma by a multimodality approach to treatment: An audit of 1632 patients☆

Received 23 January 2003; accepted 5 September 2003.

Abstract

Objective

To report on conservation of eyes with choroidal melanoma with a multimodality approach to treatment.

Design

Prospective, noncomparative, interventional case series.

Participants

All 1632 patients with choroidal melanoma treated at a single center between 1993 and 2002.

Intervention

Primary enucleation (35%), brachytherapy (31.3%), proton beam radiotherapy (16.7%), transscleral local resection (11.0%), endoresection (3.7%), transpupillary thermotherapy (2.5%), and photocoagulation (0.1%).

Main outcome measures

Primary and secondary enucleation.

Results

Logistic regression showed the main predictive factors for primary enucleation to be: age more than 60 years (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.8%–3.2%); reduced visual acuity (OR, 2.5; 95% CI, 1.9%–3.2%); posterior extension close to or involving the optic disc and fovea (OR, 1.7; 95% CI, 1.2%–2.4%); circumferential spread around the ciliary body, iris, or angle (OR, 3.1; 95% CI, 1.8%–5.5%); basal tumor diameter (OR, 3.5; 95% CI, 2.4%–5.0%); and tumor height (OR, 6.3; 95% CI, 4.5%–8.9%). After conservative treatment, the actuarial rate of secondary enucleation was 11.1% at 5 years (95% CI, 8.6%–13.6%). Cox multivariate analysis indicated the factors independently predicting secondary enucleation as: nasal/midline tumor location (risk ratio [RR], 2.6; 95% CI, 1.6%–4.4%); disc involvement (RR, 2.2; 95% CI, 1.2%–4.1%); tumor diameter (RR, 1.2; 95% CI, 1.0%–1.5%); and tumor thickness (RR, 1.8; 95% CI, 1.5%–2.1%).

Conclusions

With a multimodality approach to treatment, 65% of patients underwent conservative treatment, and of them, 89% retained their eye at 5 years, with success depending on tumor diameter, tumor thickness, disc involvement, and coronal location.

1 St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom

Correspondence to Bertil Damato, MD, PhD, St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, England, UK.

☆ Manuscript no. 230041.

The Liverpool Ocular Oncology Centre is funded by the National Specialised Commissioning Advisory Group of the Department of Health of England, London, United Kingdom.

The authors have no commercial interests in this work.

PII: S0161-6420(03)01747-0

doi:10.1016/j.ophtha.2003.09.028

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