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Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma: Comparison With Nonrandomized Historical Control Individuals

Archives of ophthalmology (1960), 2020-02, Vol.138 (2), p.136 [Peer Reviewed Journal]

Copyright American Medical Association Feb 2020 ;ISSN: 2168-6165 ;EISSN: 2168-6173 ;EISSN: 1538-3601 ;DOI: 10.1001/jamaophthalmol.2019.5132 ;PMID: 31830238

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Title:
Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma: Comparison With Nonrandomized Historical Control Individuals
Author: Shields, Carol L ; Dalvin, Lauren A ; Chang, Michael ; Mazloumi, Mehdi ; Fortin, Patricia ; McGarrey, Mark ; Martin, Andrei ; Yaghy, Antonio ; Yang, Xiaolu ; Vichitvejpaisal, Pornpattana ; Mashayekhi, Arman ; Shields, Jerry A
Subjects: Acuity ; Bevacizumab ; Bevacizumab - administration & dosage ; Combined Modality Therapy ; Edema ; Eye ; Female ; Humans ; Immunotherapy ; Intravitreal Injections ; Irradiated ; Male ; Melanoma ; Melanoma - mortality ; Melanoma - pathology ; Melanoma - physiopathology ; Melanoma - radiotherapy ; Middle Aged ; Monoclonal antibodies ; Patients ; Radiation therapy ; Retinopathy ; Retrospective Studies ; Survival analysis ; Uveal Neoplasms - mortality ; Uveal Neoplasms - pathology ; Uveal Neoplasms - physiopathology ; Uveal Neoplasms - radiotherapy ; Vascular endothelial growth factor ; Vascular Endothelial Growth Factor A - analysis ; Visual Acuity - drug effects
Is Part Of: Archives of ophthalmology (1960), 2020-02, Vol.138 (2), p.136
Description: Radiation retinopathy following plaque radiotherapy for uveal melanoma can lead to vision loss that might be avoided with prophylactic anti-vascular endothelial growth factor treatment. To determine visual outcome following prophylactic intravitreal bevacizumab in patients with plaque-irradiated uveal melanoma. Retrospective, nonrandomized, interventional cohort study at Wills Eye Hospital, Philadelphia, Pennsylvania. Prophylactic bevacizumab was administered between 2008 and 2018 to 1131 eyes with irradiated uveal melanoma (bevacizumab group) and compared with 117 eyes with irradiated uveal melanoma between 2007 and 2009 (no bevacizumab [historical control] group). Prophylactic intravitreal bevacizumab was provided at the time of plaque removal as well as 6 subsequent injections at 4-month intervals over 2 years. Visual acuity. The median patient age was 61 years, 1195 of 1248 patients were white (96%), and 632 of 1248 were women (51%). The median tumor thickness was 4.0 mm, and median distance to foveola was 3.0 mm. A difference was not identified (bevacizumab vs control group) in demographic features, clinical features, or radiation parameters. The mean follow-up was 40 months vs 56 months (mean difference, -18; 95% CI, -24 to -13; P < .001). By survival analysis, the bevacizumab group demonstrated less optical coherence tomography evidence of cystoid macular edema at 24 months (28% vs 37%; hazard ratio [HR], 1.5; 95% CI, 1.1-2.2; P = .02) and 36 months (44% vs 54%; HR, 1.5; 95% CI, 1.1-2.1; P = .01), less clinical evidence of radiation maculopathy at 24 months (27% vs 36%; HR, 1.5; 95% CI, 1.0-2.2; P = .03), 36 months (44% vs 55%; HR, 1.50; 95% CI, 1.1-2.0; P = .01), and 48 months (61% vs 66%; HR, 1.4; 95% CI, 1.0-1.9; P = .03), and less clinical evidence of radiation papillopathy at 18 months (6% vs 12%; HR, 2.0; 95% CI, 1.1-3.9; P = .04). Nonparametric analysis documented better visual acuity outcomes in the bevacizumab group at all points, including 12 months (median logMAR visual acuity [Snellen equivalent]: 0.30 [20/40] vs 0.48 [20/60]; mean difference, -0.28; 95% CI, -0.48 to -0.07; P = .02), 24 months (0.40 [20/50] vs 0.70 [20/100]; mean difference, -0.52; 95% CI, -0.75 to -0.29; P < .001), 36 months (0.48 [20/60] vs 1.00 [20/200]; mean difference, -0.49; 95% CI, -0.76 to -0.21; P = .003), and 48 months (0.54 [20/70] vs 2.00 [counting fingers]; mean difference, -0.71; 95% CI, -1.03 to -0.38; P < .001). These findings from a retrospective cohort of plaque radiotherapy and prophylactic intravitreal bevacizumab in patients with uveal melanoma suggest better visual outcomes when compared with nonrandomized historical control individuals through 4 years.
Publisher: United States: American Medical Association
Language: English
Identifier: ISSN: 2168-6165
EISSN: 2168-6173
EISSN: 1538-3601
DOI: 10.1001/jamaophthalmol.2019.5132
PMID: 31830238
Source: MEDLINE
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Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma: Comparison With Nonrandomized Historical Control Individuals

Copyright American Medical Association Feb 2020 ;ISSN: 2168-6165 ;EISSN: 2168-6173 ;EISSN: 1538-3601 ;DOI: 10.1001/jamaophthalmol.2019.5132 ;PMID: 31830238

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