Lela Polivogianis

Comparison of Survival Rates for Patients With Uveal Melanoma After Treatment With Proton Beam Irradiation or Enucleation

UNLABELLED We compared survival experiences for three groups with uveal melanoma: (1) 120 patients treated by proton beam irradiation from 1975 to 1981; (2) 235 patients treated by enucleation from 1953 to 1973 (enucleation group 1); and (3) 161 patients treated by enucleation from 1975 to 1981 (enucleation group 2). The following variables were predictive of melanoma-related deaths. TREATMENT rate ratio (ratio of the rate of death for one category of the variable relative to the rate of death for another category) of 6.32 (95% confidence interval 1.70 to 23.51) for enucleation group 1 vs proton beam, 3.06 (0.81 to 11.54) for enucleation group 2 vs proton beam, and 2.07 (1.05 to 4.07) for enucleation group 1 vs enucleation group 2. Size: rate ratio of 3.61 (1.51 to 8.64) for large (16+ mm) vs small (less than 11 mm) tumors. LOCATION rate ratio of 3.19 (1.56 to 6.53) for tumors anterior vs posterior to the equator. When death from all causes was evaluated as the outcome, the estimated rate ratios were similar. When melanoma metastasis was evaluated as the outcome, the estimated rate ratios were reduced in magnitude.

Visual outcome after proton beam irradiation of uveal melanoma

Prognostic factors for visual loss following proton irradiation of uveal melanoma were evaluated for 440 eyes treated from 1975 to 1984, with visual acuity 20/200 or better before treatment. Analysis involved Kaplan-Meier survival curves and Cox proportional hazards analysis with visual outcome defined as worse than 20/200. Prognostic factors were tumor height: rate ratio (ratio of rate of visual loss for one category of the variable relative to the rate of visual loss for a reference category of that variable) of 5.26 (95% confidence interval, 2.66-10.39) for tumors greater than 5 mm compared to tumors 3.0 mm or less in height; distance of tumor from the optic disc and fovea: rate ratio 2.59 (1.63-4.11) for tumors 2DD or less from both the optic disc and fovea compared to those greater than 2 DD from these structures. Also predictive of visual loss were tumor location close to disc only, or close to fovea only, macular detachment, worse pretreatment vision, and higher radiation doses delivered to both the disc and fovea, and lens. Regression analysis using a visual acuity scale gave similar results.

Cobalt plaque versus enucleation for uveal melanoma: comparison of survival rates.

Two hundred and twenty-three patients treated by cobalt plaque for uveal melanoma were compared with 416 patients treated by enucleation for uveal melanoma in terms of patient survival. The median follow-up time for the patients treated by cobalt plaque was 4.3 years. Kaplan-Meier survival curves were calculated up to five years following treatment based on time to tumour-related deaths. Coxs proportional hazards multivariate analysis was performed to determine which variables were related to melanoma-related deaths while controlling for age, size, and location of the tumours. Statistically significant predictive factors were location of tumour and largest tumour dimension. There was not a statistically significant difference in survival between patients treated by cobalt plaque and those treated by enucleation.

Prognostic Factors for Metastasis Following Proton Beam Irradiation of Uveal Melanomas

Prognostic indicators for the development of metastasis following proton beam irradiation of uveal melanomas were evaluated for 510 patients treated from 1975 to 1984. Thirty-three patients developed metastasis (6.5%) from 3 to 51 months following treatment. The primary site of metastasis was the liver in 28 cases (85%). Both demographic and clinical factors were considered. The three leading predictors of survival without metastasis after proton beam irradiation in order of importance were: (1) largest diameter of the tumor; (2) location of the anterior margin of the tumor; and (3) age at treatment. Worse prognosis was associated with largest tumor diameter greater than 15.0 mm, tumor involvement of the ciliary body and age at treatment older than 59 years.

Comparison of Transillumination and Histologic Slide Measurements of Tumor Diameter in Uveal Melanoma

Tumor size is an important prognostic factor for deaths due to uveal melanoma. The objectives of this study are: (1) to determine the association between largest tumor diameter assessed by clinical transillumination and largest tumor diameter assessed by measurement of the histologic slide; (2) to predict a clinical transillumination diameter for each enucleation specimen based on the best combination of histologic variables--diameter, height, location, and tumor shape; and (3) to use the predicted transillumination diameter in place of histologic diameter measurement as a prognostic factor for patients treated by enucleation in order to reevaluate previously reported survival outcomes for patients treated by proton beam and enucleation. Comparison of measurements on 40 eyes indicated that transillumination largest diameter measurements were larger than histologic slide measurements (mean difference, 2.87 mm). Multiple linear regression analysis yielded the following equation: transillumination diameter = [4.73 + (0.58 X histologic diameter) + (0.38 X histologic height) + (1.87 X anterior location)]. Using the actual and predicted transillumination measurements, the results of this study support a previously published report on these data: treatment type, tumor size, and location were predictive of melanoma-related deaths, metastases, and all deaths.

The Effects of Pre-enucleation Irradiation on the Development of Metastases from Intraocular Greene Melanoma in Hamsters

Using intraocular Greene melanoma in a hamster model, we studied the effect of pre-enucleation irradiation on the development of melanoma metastases. One group (No. = 111) was treated with 1,210 to 1,600 rads of cobaltous chloride Co 60 gamma irradiation before enucleation and the second group (No. = 100) received no irradiation. The groups did not differ with respect to presence of metastases in the 106 days after tumor implantation (chi 2 = 3.05; P = .08). However, Kaplan-Meier survival curves gave a longer time to melanoma-related death in the irradiated animals compared with the controls (log rank test, P = .0008).

Standardized Data Collection and Coding in Eye Disease Epidemiology: The Uveal Melanoma Data System

The Uveal Melanoma Data System of the Massachusetts Eye and Ear Infirmary is a computerized data-base designed for data management and analysis with a broad range of clinical research applications. The system was created in 1980 and has evolved to include standardized data collection forms for all aspects of uveal melanoma patient care such as initial examination, treatment, and follow-up, as well as precoded forms for computer entry, which facilitate quality control measures and data analysis. Excerpts from current versions of these forms are presented. The Uveal Melanoma Data System has been used for a variety of clinical epidemiologic investigations. Examples of its application, including descriptive studies, prognostic factor studies, and treatment evaluations, are discussed. The model has potential broad application for clinical ophthalmic research in other specialty areas.

A method for assessing potential bias among cancer patients recorded as “dead of other causes”. Application to cases of intraocular melanoma

By applying the Cox regression model to 226 cases of intraocular melanoma, the authors detected a statistical association between tumor‐related measurements and 42 deaths that were recorded as due to causes other than melanoma within 10 years of follow‐up. This association may reflect a number of events, including errors in assignment of cause of death and confounding from any one of several sources.