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Survival Analysis of Stereotactic Radiosurgery Compared to Enucleation for the Treatment of Choroidal and Ciliary Body Malignant Melanoma
1Cohen V. M. L., 2Rennie I. G.,
1Royal Hallamshire Hospital, The Ocular Oncology Unit (Sheffield)
2The University of Sheffield, Academic Unit of Ophthalmology and Orthoptics, Floor O, Royal Hallamshire Hospital (Sheffield)
Purpose: To compare disease patient survival following enucleation or sterotactic radiosurgery for the treatment of choroidal and ciliary body melanomas.
Methods: A retrospective cohort study was undertaken from Jan 1990 to Jan 2000 on patients who underwent either stereotactic radiosurgery or enucleation for the treatment of choroidal and ciliary body melanomas. The treatment groups were compared for age, sex, tumour location (juxtapapillary, peripheral choroid or ciliary body), tumour size and the presence of extra-scleral extension or retinal detachment. The disease free interval was recorded. Statistical analysis was performed using the Kaplan-Meier survival method and Coxs proportional hazards model.
Results: 196 patients notes were analysed. 118 underwent enucleation and 78 had stereotactic radiosurgery. Kaplan-Meier survival showed that the stereotactic group had a more favourable survival than the enucleation group (p= 0.006): the five year cumulative survival was 74% compared to 51% in the enucleation group. Tumour location was also predictive of outcome with ciliary body tumour having the worse prognosis (p=0.0015). Extra-scleral spread or retinal detachment were not predictive (both p>0.05). Coxs proportional hazards analysis demonstrated that tumour volume was highly significant in affecting the disease free interval (p=0.0001). Tumour volume and location, but not treatment modality, were independent risk factors in determining disease free interval.
Conclusions: Patient survival following stereotactic radiosurgery is comparable to survival following enucleation, life expectancy is predominantly determined by the tumour volume and location at presentation. Stereotactic radiosurgery can continue to be offered to patients who as a globe sparing treatment modality.