Elsevier

Ophthalmology Retina

Volume 5, Issue 5, May 2021, Pages 468-478
Ophthalmology Retina

Original article
Long-term Outcomes of Small Pigmented Choroidal Melanoma Treated with Primary Photodynamic Therapy

https://doi.org/10.1016/j.oret.2020.08.019Get rights and content

Purpose

To report the long-term outcomes of patients with small, pigmented, posteriorly located choroidal melanoma undergoing primary treatment using photodynamic therapy (PDT) with verteporfin at the London Ocular Oncology Service.

Design

Retrospective, interventional, consecutive case series.

Participants

All patients undergoing primary treatment using PDT with verteporfin from April 2014 to December 2015 and followed until December 2019.

Methods

This is a long-term follow-up study of the same cohort of patients previously reported by our group in 2017 and 2018.

Main Outcome Measures

Local tumor control, visual outcomes, and metastasis-free survival.

Results

Twenty-six patients were included with a mean (± standard deviation) age and tumor thickness of 62 ± 14 years and 1.3 ± 0.5 mm, respectively. Tumors were posteriorly located (mean distance to optic nerve and fovea = 2.0 ± 2.2 mm and 1.6 ± 1.5 mm, respectively), and the majority were fully pigmented (73%). Overall, patients were followed for a median (interquartile range [IQR], range) of 49.5 (15.3, 7.0–66.0) months from first PDT to last follow-up. Over the course of this study, 14 of 26 (54%) have developed a local recurrence at a median of 20.0 months (20.5, 4.7–60.9 months). The most common pattern of recurrence was an isolated increase in basal dimensions (9/14; 64%). Median (IQR) final logarithm of the minimum angle of resolution visual acuity of the whole cohort was 0.2 (0.5). The only statistically significant difference in baseline and outcome characteristics between treatment failures and nonfailures was the distance to the fovea (median [IQR], 0.5 [1.3] vs. 2.5 [2.8]; P = 0.002) and final logarithm of the minimum angle of resolution visual acuity (median [IQR], 0.50 [0.80] vs. 0.00 [0.14]; P = 0.002), respectively.

Conclusions

Although treatment of small pigmented posterior choroidal melanoma with PDT effectively preserves visual acuity, 5-year treatment-success calculated by Kaplan–Meier analysis was only 38.4%. Recurrences after PDT tend to occur along the tumor edges, often with minimal increase in thickness. Given the substantial risk of treatment failure, primary PDT with vertepofrin is recommended in exceptional cases of choroidal melanoma, for which other treatments with greater tumor control are not a feasible option.

Section snippets

Methods

This retrospective study was approved by the Moorfields Eye Hospital clinical audit department (number 456) and conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all patients at the time of treatment. Because this was a follow-up study, the same inclusion criteria and treatment parameters were used, as has been outlined in the previously described study methodology.24,25 Patients presenting to the London Ocular Oncology Service between April 2014 and

Results

Twenty-six patients were included with a mean age of 62 ± 14 years. Fifteen patients (58%) were female, and the right and left eyes were affected with equal frequency. The median (IQR, range) tumor height was 1.3 (0.7, 0.9–2.7), and the mean (± standard deviation) largest basal dimension was 5.4 ± 1.4 mm. Because included cases were, by definition, posteriorly located, the median distance to the optic disc (2.0 mm [3.0 mm; 0.0–9.0 mm]) and fovea (1.0 mm [2.5 mm; 0.0–4.5 mm]) were relatively

Discussion

Although the decision to proceed with radiotherapy for medium-size uveal melanoma tends to be a rather straightforward one, the timing of treatment for small, posteriorly located lesions is less widely agreed on given that approximately half of these patients will have visual acuity <20/200 5 years after iodine plaque brachytherapy.28 Although visual morbidity associated with ruthenium plaque brachytherapy may be less, if the posterior margin of the tumor is <3 mm to the fovea, only 25% of

Conclusions

Because of the substantial risk of recurrence, primary treatment with verteporfin PDT for small pigmented choroidal melanoma is not recommended in the majority of cases. As rare exceptions to this recommendation will arise in the real-world setting, in the instance that treatment with PDT is performed, close long-term follow-up is of paramount importance given the highly variable time to recurrence. Because most recurrences after PDT tend to occur along the tumor edges, often with minimal

References (53)

  • U.M. Schmidt-Erfurth et al.

    Photodynamic therapy for symptomatic choroidal hemangioma: visual and anatomic results

    Ophthalmology

    (2002)
  • U. Schmidt-Erfurth et al.

    Time course and morphology of vascular effects associated with photodynamic therapy

    Ophthalmology

    (2005)
  • R.A. Zaldivar et al.

    Clinicopathologic findings in choroidal melanomas after failed transpupillary thermotherapy

    Am J Ophthalmol

    (2003)
  • I.A. Barbazetto et al.

    Treatment of choroidal melanoma using photodynamic therapy

    Am J Ophthalmol

    (2003)
  • L.M. Jampol et al.

    The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: IV. Local treatment failure and enucleation in the first 5 years after brachytherapy. COMS report no. 19

    Ophthalmology

    (2002)
  • V.P. Papastefanou et al.

    Photodynamic therapy for retinal capillary hemangioma

    Eye (Lond)

    (2013)
  • D.H. Ghodasra et al.

    Photodynamic therapy for choroidal metastasis

    Am J Ophthalmol

    (2016)
  • M.A. Blasi et al.

    Photodynamic therapy for vasoproliferative retinal tumors

    Retina

    (2006)
  • R.F. O’Day et al.

    Australian and New Zealand study of photodynamic therapy in choroidal amelanotic melanoma

    Retina

    (2020)
  • E.B. Turkoglu et al.

    photodynamic therapy as primary treatment for small choroidal melanoma

    Retina

    (2019)
  • D. Nowis et al.

    Direct tumor damage mechanisms of photodynamic therapy

    Acta Biochim Pol

    (2005)
  • C.J. Gomer

    Preclinical examination of first and second generation photosensitizers used in photodynamic therapy

    Photochem Photobiol

    (1991)
  • T.J. Dougherty

    Photosensitization of malignant tumors

    Semin Surg Oncol

    (1986)
  • D.T. Tse et al.

    Hematoporphyrin photoradiation therapy for intraocular and orbital malignant melanoma

    Arch Ophthalmol

    (1984)
  • V.H. Gonzalez et al.

    Photodynamic therapy of pigmented choroidal melanomas

    Invest Ophthalmol Vis Sci

    (1995)
  • L.H. Young et al.

    Photodynamic therapy of pigmented choroidal melanomas using a liposomal preparation of benzoporphyrin derivative

    Arch Ophthalmol

    (1996)

    • Cited by (6)

    • Long term results of photodynamic therapy in intraocular tumors

      2023, Photodiagnosis and Photodynamic Therapy

    • Laser treatment for choroidal melanoma: Current concepts

      2023, Survey of Ophthalmology
      Citation Excerpt :

      Current lasers: Overall, the average metastatic rate for TTT has been 10.3% where the local control was 81.3%.72,85,94,109,110,116,119 In a recent report, PDT showed a metastatic rate of 38% in a study involving 26 patients followed up over 15 months.95 Thermal treatments are known to be associated with shrinkage of collagen and fibrovascular fronds, and thus induce tractional events.59,123

    • Documented growth of a halo choroidal nevus

      2021, Journal Francais d'Ophtalmologie

    • Laser Treatment in Intraocular Tumors

      2023, Retina Lasers in Ophthalmology: Clinical Insights and Advancements

    • New perspectives for eye-sparing treatment strategies in primary uveal melanoma

      2022, Cancers

    • Detecting progression of treated choroidal melanomas: Is ultrasonography necessary?

      2021, Cancers

    The research was supported Moorfields Eye Hospital NHS Foundation Trust, the National Institute for Health Research, Biomedical Research Center and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health.

    Submitted to the American Academy of Ophthalmology annual meeting.

    Disclosure(s): All authors have completed and submitted the ICMJE disclosures form. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at the Moorfields Eye Hospital approved the study. All research adhered to the tenets of the Declaration of Helsinki. All participants provided informed consent.

    No animal subjects were included in this study.

    Author Contributions:

    Conception and design: Fabian, Arora, Cohen, Sagoo

    Data collection: Roelofs, Fabian, Arora, Cohen, Sagoo

    Analysis and interpretation: Roelofs, Sagoo

    Obtained funding: N/A

    Overall responsibility: Roelofs, Fabian, Arora, Cohen, Sagoo

    View full text
    © 2020 by the American Academy of Ophthalmology