Sebastian Eskelin

Tumor doubling times in metastatic malignant melanoma of the uvea: Tumor progression before and after treatment

OBJECTIVE To obtain estimates of growth rate of metastatic uveal melanoma to infer appropriate follow-up programs and to assess the impact of current chemoimmunotherapy regimens. DESIGN Retrospective case series. PARTICIPANTS Of 70 consecutive patients diagnosed with metastatic uveal melanoma from 1986 through 1998, 37 patients who attended regular follow-up and had measurable metastases were eligible for this study. METHODS Tumor doubling time (DT) was calculated by the Schwartz formula using three presumed sizes of metastasis at last negative follow-up. DT was compared according to tumor characteristics, and time of micrometastasis was estimated. MAIN OUTCOME MEASURES Doubling time of untreated and treated metastases. RESULTS Doubling time of untreated metastases ranged from 34 to 220 days (median, 63 days). Regardless of the presumed size of metastasis at last screening, two thirds of the metastases had a DT between 30 and 80 days. No significant correlation between DT and the observed disease-free interval was detected. Assuming constant growth rate, most metastases had predictably initiated within 5 years before primary treatment. Mean DT during active treatment of metastases in 18 patients who did not show an objective response ranged from 25 to 2619 days (median, 255 days). CONCLUSIONS Based on the estimated growth rates, a rational follow-up interval to detect metastatic uveal melanoma would be 4 to 6 months. Primary uveal melanomas that develop clinically detectable metastasis after conservative therapy may micrometastasize several years before treatment. These estimates are rough and must be confirmed by prospective studies. Current chemoimmunotherapy regimens slow down the growth rate of metastases even if objective response is not obtained.

Metastatic uveal melanoma.

Metastatic melanoma (stage IV in Tumor, Node, Metastasis Classification) is believed to be the unresolved problem in managing patients with malignant melanoma of the choroid and ciliary body. More than half of these patients will eventually develop hematogenous metastases, which only exceptionally are curable. Metastasis is the single leading cause of death of patients with uveal melanoma, both short term and long term. Kaplan-Meier estimates of 5and 15-year melanoma-related mortality range from 26% to 32% and from 45% to 50%, respectively (see ). However, this method does not take into account competing causes of death. By 15 years, these competing causes gradually outnumber annual melanoma-related deaths, but metastases still amount to one third of annual deaths long term. Overall, 7 and 2 times as many patients die of uveal melanoma as die of second cancer and nonneoplastic disease, respectively. The first site of metastasis is the liver in approximately 90% of patients, but later spread to the lungs, bone, and skin is frequent. Of patients with newly diagnosed metastases who participate in annual reviews that include liver imaging, 80% have only hepatic metastases, 12% have hepatic and extrahepatic, and 8% have only extrahepatic dissemination. This pattern of dissemination differs from that of cutaneous melanoma, which typically metastasizes to the lymph nodes, lungs, and brain, and it is important to understand that these 2 are distinct diseases. Uveal melanoma rarely metastasizes to the regional lymph nodes, but it can do so if it invades the conjunctiva. This focused review summarizes the latest findings with regard to epidemiology, kinetics, diagnostic screening, staging, and management of metastases from uveal melanoma.

Photodynamic therapy with verteporfin to induce regression of aggressive retinal astrocytomas

Purpose:  To evaluate the effect of photodynamic therapy (PDT) with verteporfin on symptomatic, aggressive retinal astrocytomas.

Mortality after uveal and conjunctival melanoma: which tumour is more deadly?

Purpose:  We aimed to model and compare mortality rates for uveal melanoma (UM) and conjunctival melanoma (CM) by adjusting for differences in tumour size and local recurrence.

Management of choroidal melanomas less than 10 mm in largest basal diameter with a 10-mm ruthenium plaque.

Purpose: To assess tumor control, complications, and vision after brachytherapy for posterior choroidal melanoma <10 mm in largest basal diameter with the 10-mm ruthenium plaque. Methods: This was a retrospective cohort study of consecutive choroidal melanomas <10 mm by largest basal diameter in a national ocular oncology service in 1998 to 2010. The median dose was 116 Gy (range, 80–194 Gy) to the apex and 327 Gy (range, 201–824 Gy) to the sclera. The median tumor height and largest basal diameter were 1.9 mm (range, 0.4–5.2 mm) and 7.0 mm (range, 3.3–9.6 mm), respectively. The median distance to disk and foveola was 3.0 mm (range, 0–7.5 mm) and 2.0 mm (range, 0–8.5 mm), respectively. Results: Four recurrences occurred at a median of 1.4 years (range, 0.6–3.1 years) after irradiation. Five-year cumulative incidence of local recurrence was 9% (95% confidence interval [CI], 3–20). Six patients died at a median of 4.2 years (range, 0.28–8.6 years) after treatment, one with evidence of metastases. At 5 years, 57% (95% CI, 31–79), 72% (95% CI, 58–85), and 97% (95% CI, 88–100) of eyes were free of any maculopathy, radiation maculopathy, and optic neuropathy, respectively. Cumulative incidence of developing low vision and blindness were 17% (95% CI, 7–31) and 3% (95% CI, 2–12) at 5 years, respectively. Thickness >3.0 mm, largest basal diameter >7.0 mm, and location ⩽1.5 mm of foveola were associated with visual loss. Conclusion: Local tumor control and vision outcomes support the use of 10-mm ruthenium plaques in managing smallest choroidal melanomas.

Long-term progression-free survival in metastatic uveal melanoma after chemoimmunotherapy and consolidation thermoablation

recommended that existing guidelines be adapted to each patient. Consideration should be given to previous cardiovascular risk factors; the volume of disease and its anatomical relation with great vessels is also likely related. Insufficient data exist regarding the relevance of factors such as histology, location of metastasis, or the use of particular medications to include them in formal recommendations. Thus, it is critical that patients with GCTs be managed in centers with extensive experience on the treatment of this disease and their potential complications.