Local Failure after Episcleral Brachytherapy for Posterior Uveal Melanoma: Patterns, Risk Factors and Management

Abstract Importance A small percentage of patients with uveal melanoma will experience local recurrence following brachytherapy. An understanding of the recurrence patterns can improve early recognition and management of local treatment failure. Objective To evaluate the patterns, the risk factors and the management of recurrence following brachytherapy in patients with posterior uveal melanoma. Design Retrospective cohort study. Setting Multispecialty tertiary care center. Participants 375 eyes treated with episcleral brachytherapy for posterior uveal melanoma from January 2004 to December 2014. Exclusion criteria included inadequate follow-up (< 1 year) and previous radiation therapy. Main outcomes and measures Local control rate and time to recurrence were the primary end points. Kaplan-Meier estimation and Cox proportional hazards models were conducted to identify risk factors of recurrence. Results 21 patients (5.6%) experienced recurrence (follow up range 12-156 months; median 47 months). The median time to recurrence was 18 months (range 4-156 months). Five-year estimated local recurrence rate was 6.6%. The majority (90.5%) of the recurrences occurred within the first 5 years. The predominant site of recurrence was at the tumor margin (12 patients, 57.1%). Univariate analysis identified 3 statistical significant recurrence risk factors: advanced age, largest basal diameter (LBD) and the use of adjuvant transpupillary thermotherapy (TTT). Recurrent tumors were managed by repeat brachytherapy, TTT or enucleation. Conclusions and Relevance: Local recurrences following brachytherapy are uncommon 5 year following episcleral brachytherapy. Follow-up intervals can be adjusted to reflect time to recurrence. Most of the eyes with recurrent tumor can be salvaged by conservative methods.