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Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study.
Ophthalmology 2013; 120(5):1004-11O

Abstract

PURPOSE

To identify risk factors and outcome of scleral necrosis after plaque radiotherapy of uveal melanoma.

DESIGN

Case-control study.

PARTICIPANTS

A total of 73 cases with scleral necrosis and 73 controls without necrosis after plaque radiotherapy. Controls were matched for anteroposterior tumor epicenter and follow-up duration.

INTERVENTION

Plaque radiotherapy with iodine-125, cobalt-60, iridium-192, or ruthenium-106.

MAIN OUTCOME MEASURES

Scleral necrosis.

RESULTS

Of 5057 patients treated with plaque radiotherapy for uveal melanoma, 73 (1%) developed radiotherapy-induced scleral necrosis. Scleral necrosis occurred in <1% of patients (3/1140) when plaque radiotherapy was used for tumors <3 mm in thickness, 1% of patients (33/3155) with 3- to 8-mm tumor thickness, and 5% of patients (37/762) with >8-mm-thick tumors. On the basis of tumor location, scleral necrosis was detected after plaque radiotherapy of iris melanoma in 0% of patients (0/91), ciliary body melanoma in 29% of patients (67/235), and choroid melanoma in <1% of patients (6/4731). The mean time interval between plaque radiotherapy and scleral necrosis was 32 months (median, 23 months; range, 4-126 months). The mean basal dimension of scleral necrosis was 4 mm (median, 3 mm; range, 1-15 mm), equivalent to 29% of mean tumor base (median, 24%; range, 6%-100%) and 22% of mean plaque size (median, 19%; range, 5%-75%). Multivariate analysis of factors that predicted clinically evident scleral necrosis included ciliary body (P = 0.0001) and pars plana to ora serrata (P < 0.0001) locations of anterior tumor margin, tumor thickness ≥ 6 mm (P = 0.0001), and radiation dose ≥ 400 Gy to the outer sclera (P = 0.0455). Scleral necrosis remained stable in 48% of patients (35/73), increased in size/severity in 48% of patients (35/73), or progressed to scleral perforation in 4% of patients (3/73) over a mean follow-up of 79 months (median, 54 months; range, 5-351 months). Treatment of scleral necrosis included observation in 81% of patients (59/73), scleral patch graft in 14% of patients (10/73), and enucleation in 5% of patients (4/73).

CONCLUSIONS

Scleral necrosis after plaque radiotherapy of uveal melanoma was detected in 1% of cases. Factors predictive of scleral necrosis included increasing tumor thickness, ciliary body and peripheral choroidal location, and higher radiation dose to sclera. Most patients (81%) did not require treatment, and 4% evolved to full-thickness perforation.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Authors+Show Affiliations

Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23347983

Citation

Kaliki, Swathi, et al. "Scleral Necrosis After Plaque Radiotherapy of Uveal Melanoma: a Case-control Study." Ophthalmology, vol. 120, no. 5, 2013, pp. 1004-11.
Kaliki S, Shields CL, Rojanaporn D, et al. Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study. Ophthalmology. 2013;120(5):1004-11.
Kaliki, S., Shields, C. L., Rojanaporn, D., Badal, J., Devisetty, L., Emrich, J., ... Shields, J. A. (2013). Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study. Ophthalmology, 120(5), pp. 1004-11. doi:10.1016/j.ophtha.2012.10.021.
Kaliki S, et al. Scleral Necrosis After Plaque Radiotherapy of Uveal Melanoma: a Case-control Study. Ophthalmology. 2013;120(5):1004-11. PubMed PMID: 23347983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study. AU - Kaliki,Swathi, AU - Shields,Carol L, AU - Rojanaporn,Duangnate, AU - Badal,Josep, AU - Devisetty,Laxmi, AU - Emrich,Jacqueline, AU - Komarnicky,Lydia, AU - Shields,Jerry A, Y1 - 2013/01/21/ PY - 2012/08/03/received PY - 2012/10/16/revised PY - 2012/10/16/accepted PY - 2013/1/26/entrez PY - 2013/1/26/pubmed PY - 2013/6/26/medline SP - 1004 EP - 11 JF - Ophthalmology JO - Ophthalmology VL - 120 IS - 5 N2 - PURPOSE: To identify risk factors and outcome of scleral necrosis after plaque radiotherapy of uveal melanoma. DESIGN: Case-control study. PARTICIPANTS: A total of 73 cases with scleral necrosis and 73 controls without necrosis after plaque radiotherapy. Controls were matched for anteroposterior tumor epicenter and follow-up duration. INTERVENTION: Plaque radiotherapy with iodine-125, cobalt-60, iridium-192, or ruthenium-106. MAIN OUTCOME MEASURES: Scleral necrosis. RESULTS: Of 5057 patients treated with plaque radiotherapy for uveal melanoma, 73 (1%) developed radiotherapy-induced scleral necrosis. Scleral necrosis occurred in <1% of patients (3/1140) when plaque radiotherapy was used for tumors <3 mm in thickness, 1% of patients (33/3155) with 3- to 8-mm tumor thickness, and 5% of patients (37/762) with >8-mm-thick tumors. On the basis of tumor location, scleral necrosis was detected after plaque radiotherapy of iris melanoma in 0% of patients (0/91), ciliary body melanoma in 29% of patients (67/235), and choroid melanoma in <1% of patients (6/4731). The mean time interval between plaque radiotherapy and scleral necrosis was 32 months (median, 23 months; range, 4-126 months). The mean basal dimension of scleral necrosis was 4 mm (median, 3 mm; range, 1-15 mm), equivalent to 29% of mean tumor base (median, 24%; range, 6%-100%) and 22% of mean plaque size (median, 19%; range, 5%-75%). Multivariate analysis of factors that predicted clinically evident scleral necrosis included ciliary body (P = 0.0001) and pars plana to ora serrata (P < 0.0001) locations of anterior tumor margin, tumor thickness ≥ 6 mm (P = 0.0001), and radiation dose ≥ 400 Gy to the outer sclera (P = 0.0455). Scleral necrosis remained stable in 48% of patients (35/73), increased in size/severity in 48% of patients (35/73), or progressed to scleral perforation in 4% of patients (3/73) over a mean follow-up of 79 months (median, 54 months; range, 5-351 months). Treatment of scleral necrosis included observation in 81% of patients (59/73), scleral patch graft in 14% of patients (10/73), and enucleation in 5% of patients (4/73). CONCLUSIONS: Scleral necrosis after plaque radiotherapy of uveal melanoma was detected in 1% of cases. Factors predictive of scleral necrosis included increasing tumor thickness, ciliary body and peripheral choroidal location, and higher radiation dose to sclera. Most patients (81%) did not require treatment, and 4% evolved to full-thickness perforation. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article. SN - 1549-4713 UR - https://www.unboundmedicine.com/medline/citation/23347983/Scleral_necrosis_after_plaque_radiotherapy_of_uveal_melanoma:_a_case_control_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0161-6420(12)01008-1 DB - PRIME DP - Unbound Medicine ER -