Retrospective Analysis of Radiation-induced Complications of Uveal Melanoma Patients Treated with Brachytherapy in the Era of Anti-VEGF.

To associate clinical factors and radiation doses delivered by iodine-125 plaque brachytherapy to visual outcomes and development of radiation-induced ocular complications in patients with uveal melanoma in the era of anti-VEGF injections. Retrospective cohort study. Retrospective chart review was performed for 225 patients treated with iodine-125 brachytherapy for uveal melanoma. The effects of radiation doses (focal doses, average dose to the entire eye, and integral dose) on visual outcomes and development of radiation complications (radiation retinopathy, radiation optic neuropathy, vitreous hemorrhage, and neovascular glaucoma) were analyzed using Multivariate Cox Regression Analysis. Median follow-up was 33.6 months (range, 12 - 105.6). Radiation retinopathy was associated with younger age, tumor distance to optic nerve < 6 mm, and maximum radiation dose to fovea. Radiation optic neuropathy was associated with white race, tumor distance to optic nerve < 6 mm, and integral radiation dose. Vitreous hemorrhage was associated with white race and integral radiation dose. Incidence of neovascular glaucoma was low in our study, with 2 patients (0.9%) developing the complication. Of the 123 patients who developed radiation retinopathy, 82 patients (66.7% of radiation retinopathy patients, 37.3% of total patients) received anti-VEGF injections. Our study found multiple associations between radiation doses and complications as well as visual outcomes on multivariate analysis. Given that the majority of our patients who developed radiation retinopathy received anti-VEGF injections, our study helps illustrate the course and progression of radiation-induced complications in the new era of anti-VEGF.

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Copyright © 2023. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Financial Disclosures: Amy Schefler: Grants: Regeneron (Tarrytown, New York, USA), Genentech (South San Francisco, California, USA), Aura Biosciences (Boston, Massachusetts, USA); Consultant: Regeneron, Genentech, Aura Biosciences; Payment for legal testimony: Medicolegal work; Committee Leadership: Diabetic Retinopathy Clinical Research (DRCR) Network. Devin Olek: Support for funding/meetings: Houston Methodist Hospital (Houston, Texas, USA)