Scleral necrosis after brachytherapy for uveal melanoma: Analysis of risk factors.
brachytherapy
scleral necrosis
uveal melanoma
Journal
Clinical & experimental ophthalmology
ISSN: 1442-9071
Titre abrégé: Clin Exp Ophthalmol
Pays: Australia
ID NLM: 100896531
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
revised:
27
03
2021
received:
24
01
2021
accepted:
30
03
2021
pubmed:
19
4
2021
medline:
1
9
2021
entrez:
18
4
2021
Statut:
ppublish
Résumé
Radiation-induced scleral necrosis (RISN) is a rare, but a serious complication of brachytherapy for uveal melanoma. We aimed at analysing the incidence, timing and risk factors associated with development of RISN in a large institutional series. All consecutive cases with brachytherapy for uveal melanoma treated by the Departments of Ophthalmology and Radiotherapy at University Hospital Essen between 1999 and 2016 were eligible. Development of RISN during the post-treatment follow-up was recorded. A 1:2 propensity score matched case-control study was performed for the evaluation of the prognostic value of different tumour- and treatment-associated parameters. RISN was documented in 115 (2.9%) of 3960 patients with uveal melanoma included in the final analysis, and occurred at the mean 30.3 months (range: 1.26-226 months) after brachytherapy. In the whole cohort, younger age (p = 0.042), plaque type (p = 0.001) and ciliary body involvement (p < 0.0001) were independently associated with the RISN occurrence. In the case-control study, multivariable weighted proportional hazard analysis discovered the association of the following additional tumour- and treatment-associated characteristics with RISN: posterior tumour margin anterior to equatorial region (p = 0.0003), extraocular tumour extension (p = <0.0001), scleral contact dose (p = <0.0001), conjunctival dehiscence after therapy (p = 0.0001), disinsertion of the superior rectus muscle (p = 0.001) and the glaucoma medication (p = 0.014). Our study confirms RISN as a rare complication, which might occur even years later after the brachytherapy for uveal melanoma. Alongside with scleral dose five other tumour and therapy related factors predict the risk of RISN after brachytherapy for uveal melanoma were established.
Sections du résumé
BACKGROUND
BACKGROUND
Radiation-induced scleral necrosis (RISN) is a rare, but a serious complication of brachytherapy for uveal melanoma. We aimed at analysing the incidence, timing and risk factors associated with development of RISN in a large institutional series.
METHODS
METHODS
All consecutive cases with brachytherapy for uveal melanoma treated by the Departments of Ophthalmology and Radiotherapy at University Hospital Essen between 1999 and 2016 were eligible. Development of RISN during the post-treatment follow-up was recorded. A 1:2 propensity score matched case-control study was performed for the evaluation of the prognostic value of different tumour- and treatment-associated parameters.
RESULTS
RESULTS
RISN was documented in 115 (2.9%) of 3960 patients with uveal melanoma included in the final analysis, and occurred at the mean 30.3 months (range: 1.26-226 months) after brachytherapy. In the whole cohort, younger age (p = 0.042), plaque type (p = 0.001) and ciliary body involvement (p < 0.0001) were independently associated with the RISN occurrence. In the case-control study, multivariable weighted proportional hazard analysis discovered the association of the following additional tumour- and treatment-associated characteristics with RISN: posterior tumour margin anterior to equatorial region (p = 0.0003), extraocular tumour extension (p = <0.0001), scleral contact dose (p = <0.0001), conjunctival dehiscence after therapy (p = 0.0001), disinsertion of the superior rectus muscle (p = 0.001) and the glaucoma medication (p = 0.014).
CONCLUSIONS
CONCLUSIONS
Our study confirms RISN as a rare complication, which might occur even years later after the brachytherapy for uveal melanoma. Alongside with scleral dose five other tumour and therapy related factors predict the risk of RISN after brachytherapy for uveal melanoma were established.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
357-367Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The Authors. Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.
Références
Kaliki S, Shields CL. Uveal melanoma: relatively rare but deadly cancer. Eye. 2017;31:241-257.
Virgili G, Gatta G, Ciccolallo L, et al. Incidence of uveal melanoma in Europe. Ophthalmology. 2007;114:2309-2315.
Biewald E, Lautner H, Gok M, et al. Endoresection of large uveal melanomas: clinical results in a consecutive series of 200 cases. Br J Ophthalmol. 2017;101:204-208.
Chang MY, McCannel TA. Local treatment failure after globe-conserving therapy for choroidal melanoma. Br J Ophthalmol. 2013;97:804-811.
Foerster MH, Bornfeld N, Schulz U, Wessing A, Meyer-Schwickerath G. Complications of local beta radiation of uveal melanomas. Graefes Arch Clin Exp Ophthalmol. 1986;224:336-340.
Kaliki S, Shields CL, Rojanaporn D, et al. Scleral necrosis after plaque radiotherapy of uveal melanoma: a case-control study. Ophthalmology. 2013;120:1004-1011.
Messmer E, Bornfeld N, Foerster M, Schilling H, Wessing A. Histopathologic findings in eyes treated with a ruthenium plaque for uveal melanoma. Graefes Arch Clin Exp Ophthalmol. 1992;230:391-396.
Petrovich Z, McDonnell JM, Palmer D, Langholz BM, Liggett PE. Histopathologic changes following irradiation for uveal tract melanoma. Am J Clin Oncol. 1994;17:298-306.
Tarmann L, Wackernagel W, Ivastinovic D, Schneider M, Winkler P, Langmann G. Tumor parameters predict the risk of side effects after ruthenium-106 plaque brachytherapy of uveal melanomas. PLoS One. 2017;12:e0183833.
Gunduz K, Shields CL, Shields JA, Cater J, Freire JE, Brady LW. Plaque radiotherapy of uveal melanoma with predominant ciliary body involvement. Arch Ophthalmol. 1999;117:170-177.
Shields CL, Naseripour M, Cater J, et al. Plaque radiotherapy for large posterior uveal melanomas (> or =8-mm thick) in 354 consecutive patients. Ophthalmology. 2002;109:1838-1849.
Puusaari I, Heikkonen J, Kivela T. Ocular complications after iodine brachytherapy for large uveal melanomas. Ophthalmology. 2004;111:1768-1777.
Radin PP, Lumbroso-Le Rouic L, Levy-Gabriel C, Dendale R, Sastre X, Desjardins L. Scleral necrosis after radiation therapy for uveal melanomas: report of 23 cases. Graefes Arch Clin Exp Ophthalmol. 2008;246:1731-1736.
Watson PG, Young RD. Scleral structure, organisation and disease. A review. Exp Eye Res. 2004;78:609-623.
Fluhs D, Anastassiou G, Wening J, Sauerwein W, Bornfeld N. The design and the dosimetry of bi-nuclide radioactive ophthalmic applicators. Med Phys. 2004;31:1481-1488.
Stockel E, Eichmann M, Fluhs D, et al. Dose distributions and treatment margins in ocular brachytherapy with 106Ru eye plaques. Ocul Oncol Pathol. 2018;4:122-128.
Sauerwein W, Stannard CE. Auge und Orbita. In: Bamberg M, Molls M, Sack H, Zuckschwerdt W, eds. Radioonkologie Band 2: Klinik. New York: Verlag München Wien; 2009:294-316.
Barlow WE, Ichikawa L, Rosner D, Izumi S. Analysis of case-cohort designs. J Clin Epidemiol. 1999;52:1165-1172.
Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical approach to multiple testing. J R Statist Soc B. 1995;57:289-300.
Rushing C, Bulusu A, Hurwitz HI, Nixon AB, Pang H. A leave-one-out cross-validation SAS macro for the identification of markers associated with survival. Comput Biol Med. 2015;57:123-129.
Sagermann RH, Alberti WE. Radiotherapy of intraocular and orbital tumors. Radiosensitivity of Ocular and Orbital Structures. Vol 269-280. Berlin Heidelberg: Springer; 2003:271.
Macfaul PA, Bedford MA. Ocular complications after therapeutic irradiation. Br J Ophthalmol. 1970;54:237-247.
Correa ZM, Augsburger JJ, Freire J, Eagle RC Jr. Early-onset scleral necrosis after iodine I 125 plaque radiotherapy for ciliochoroidal melanoma. Arch Ophthalmol. 1999;117:259-261.
Chaudhry IA, Liu M, Shamsi FA, Arat YO, Shetlar DJ, Boniuk M. Corneoscleral necrosis after episcleral Au-198 brachytherapy of uveal melanoma. Retina. 2009;29:73-79.
Geraghty B, Jones SW, Rama P, Akhtar R, Elsheikh A. Age-related variations in the biomechanical properties of human sclera. J Mech Behav Biomed Mater. 2012;16:181-191.
Coudrillier B, Pijanka J, Jefferys J, Sorensen T, Quigley HA, Boote C, Nguyen TD. Effects of age and diabetes on scleral stiffness. J Biomech Eng. 2015 Jul;137(7):0710071-07100710.
Ebneter A, Haner NU, Zinkernagel MS. Metrics of the normal anterior sclera: imaging with optical coherence tomography. Graefes Arch Clin Exp Ophthalmol. 2015;253:1575-1580.
Rada JA, Achen VR, Penugonda S, Schmidt RW, Mount BA. Proteoglycan composition in the human sclera during growth and aging. Invest Ophthalmol Vis Sci. 2000;41:1639-1648.
Ihanamaki T, Salminen H, Saamanen AM, et al. Age-dependent changes in the expression of matrix components in the mouse eye. Exp Eye Res. 2001;72:423-431.
Wilkinson DA, Kolar M, Fleming PA, Singh AD. Dosimetric comparison of 106Ru and 125I plaques for treatment of shallow (< or =5 mm) choroidal melanoma lesions. Br J Radiol. 2008;81:784-789.
Lommatzsch P. Morphological and functional changes in the rabbit eye on exposure of the dorsal bulb section to beta rays (106Ru-106Rh). Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1968;176:100-125.
Buckhurst HD, Gilmartin B, Cubbidge RP, Logan NS. Measurement of scleral thickness in humans using anterior segment optical coherent tomography. PLoS One. 2015;10:e0132902.
Norman RE, Flanagan JG, Rausch SM, et al. Dimensions of the human sclera: thickness measurement and regional changes with axial length. Exp Eye Res. 2010;90:277-284.
Sevel D. Necrogranulomatous scleritis. Effects on the sclera of vascular deprivation. Br J Ophthalmol. 1968;52:453-460.
Groenewald C, Konstantinidis L, Damato B. Effects of radiotherapy on uveal melanomas and adjacent tissues. Eye. 2013;27:163-171.
Shields CL, Shields JA, Karlsson U, Menduke H, Brady LW. Enucleation after plaque radiotherapy for posterior uveal melanoma. Histopathologic findings. Ophthalmology. 1990;97:1665-1670.
Correa ZM, Huth B, Augsburger JJ. Scleral necrosis in patients with posterior uveal melanomas evaluated by transcleral fine needle aspiration biopsy and treated by 125I plaque. Arq Bras Oftalmol. 2018;81:330-335.
Techna Institute for the Advancement of Technology for Health. Techna Institute for the Advancement of Technology for Health, https://technainstitute.com/the-sortt-solution-helping-to-reduce-eye-tissue-toxicity-after-radiation/.