Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study.
Adult
Aged
Antineoplastic Agents
/ therapeutic use
Brachytherapy
Chemotherapy, Adjuvant
Combined Modality Therapy
Conjunctival Neoplasms
/ mortality
Cryotherapy
Female
Humans
Kaplan-Meier Estimate
Male
Melanoma
/ mortality
Middle Aged
Neoplasm Recurrence, Local
Protons
Retrospective Studies
Treatment Outcome
Conjunctiva
Epidemiology
Pathology
Treatment Medical
Treatment Surgery
Journal
The British journal of ophthalmology
ISSN: 1468-2079
Titre abrégé: Br J Ophthalmol
Pays: England
ID NLM: 0421041
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
12
03
2020
revised:
26
06
2020
accepted:
09
08
2020
pubmed:
7
9
2020
medline:
15
2
2022
entrez:
6
9
2020
Statut:
ppublish
Résumé
To relate conjunctival melanoma characteristics to local control. Retrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system. 288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2-8.9%), 19.3% (14.4-25.5%) and 36.9% (26.5-49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence. This multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.
Sections du résumé
BACKGROUND
To relate conjunctival melanoma characteristics to local control.
METHODS
Retrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.
RESULTS
288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2-8.9%), 19.3% (14.4-25.5%) and 36.9% (26.5-49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.
CONCLUSION
This multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.
Identifiants
pubmed: 32892167
pii: bjophthalmol-2020-316293
doi: 10.1136/bjophthalmol-2020-316293
pmc: PMC8479743
doi:
Substances chimiques
Antineoplastic Agents
0
Protons
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1358-1364Investigateurs
Paul T Finger
(PT)
Sarah E Coupland
(SE)
Daniel M Albert
(DM)
Anush G Amiryan
(AG)
Svetlana Saakyan Claudia Auw-Hä Drich
(SSCA)
Diane Baker
(D)
Raymond Barnhill
(R)
José M Caminal
(JM)
William L Caroll
(WL)
Nathalie Cassoux
(N)
Laurence G Desjardins
(LG)
François Doz
(F)
Gaelle Pierron
(G)
Jaume Catalá -Mora
(JC)
Guillermo Chantada
(G)
Patricia Ché Vez-Barrios
(PC)
R Max Conway
(RM)
Bertil E Damato
(BE)
Hakan Demirci
(H)
Jonathan J Dutton
(JJ)
Bita Esmaeli
(B)
Victor G Prieto
(VG)
Michelle Williams
(M)
Brenda L Gallie
(BL)
Gerardo F Graue
(GF)
Hans E Grossniklaus
(HE)
Steffen Heegaard
(S)
Leonard M Holbach
(LM)
Santosh G Honavar
(SG)
Martine J Jager
(MJ)
Tero Kivelä
(T)
Emma Kujala
(E)
Emma Kujala
(E)
Livia Lumbroso-Le Rouic
(L)
Ashwin C Mallipatna
(AC)
Giulio M Modorati
(GM)
Francis L Munier
(FL)
Timothy G Murray
(TG)
Anna C Pavlick
(AC)
Jacob Pe'er
(J)
David E Pelayes
(DE)
Manuel Jorge Rodriguez
(MJ)
Wolfgang A G Sauerwein
(WAG)
Ekaterina Semenova
(E)
Stefan Seregard
(S)
Carol Shields
(C)
E Rand Simpson
(ER)
Arun D Singh
(AD)
Shigenobu Suzuki
(S)
Mary Kay Washington
(MK)
Valerie A White
(VA)
Mathew W Wilson
(MW)
Christian W Wittekind
(CW)
Vivian Yin
(V)
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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