TY - JOUR
T1 - Patterns of care and outcomes of proton and eye plaque brachytherapy for uveal melanoma
T2 - Review of the National Cancer Database
AU - Lin, Alexander J.
AU - Rao, Yuan J.
AU - Acharya, Sahaja
AU - Schwarz, Julie
AU - Rao, Prabakar Kumar
AU - Grigsby, Perry
N1 - Publisher Copyright:
© 2017 American Brachytherapy Society
PY - 2017/11
Y1 - 2017/11
N2 - Purpose To examine national practice patterns and outcomes of eye plaque brachytherapy compared to proton external beam radiotherapy in the treatment of choroid melanoma. Methods and Materials Demographic and clinical data for 1224 patients with choroid melanoma treated with either brachytherapy or proton beam therapy from 2004 to 2013 were obtained from the National Cancer Database. Logistic regression and propensity score matching was used to create a 1:1 matched cohort. Kaplan-Meier and Cox regression analyses were performed to evaluate survival in brachytherapy and proton groups. Results Median followup was 37 and 29 months for brachytherapy and protons, respectively. Most patients were treated with brachytherapy (n = 996) vs. protons (n = 228). Proton patients came from more urban, affluent, and educated zip codes, and they were more likely to be treated at an academic center (all p < 0.004). In the propensity-score matched cohort, 2-year overall survival was 97% vs. 93%, and 5-year overall survival was 77% vs. 51% for brachytherapy and protons, respectively (p = 0.008). Multivariate Cox regression found older age (hazard ratio [HR] = 1.06, 95% confidence interval (CI) = 1.03–1.09), larger tumor diameter (12–18 mm, HR = 2.48, 95% CI = 1.40–4.42, >18 mm, HR = 6.41, 95% CI = 1.45–28.35), and protons (HR = 1.89, 95% CI = 1.06–3.37) were negative prognosticators of survival. Conclusions Patients selected for proton treatment have inferior survival outcomes compared to brachytherapy in this retrospective analysis. There may be unaccounted variables that influence survival, warranting further prospective studies.
AB - Purpose To examine national practice patterns and outcomes of eye plaque brachytherapy compared to proton external beam radiotherapy in the treatment of choroid melanoma. Methods and Materials Demographic and clinical data for 1224 patients with choroid melanoma treated with either brachytherapy or proton beam therapy from 2004 to 2013 were obtained from the National Cancer Database. Logistic regression and propensity score matching was used to create a 1:1 matched cohort. Kaplan-Meier and Cox regression analyses were performed to evaluate survival in brachytherapy and proton groups. Results Median followup was 37 and 29 months for brachytherapy and protons, respectively. Most patients were treated with brachytherapy (n = 996) vs. protons (n = 228). Proton patients came from more urban, affluent, and educated zip codes, and they were more likely to be treated at an academic center (all p < 0.004). In the propensity-score matched cohort, 2-year overall survival was 97% vs. 93%, and 5-year overall survival was 77% vs. 51% for brachytherapy and protons, respectively (p = 0.008). Multivariate Cox regression found older age (hazard ratio [HR] = 1.06, 95% confidence interval (CI) = 1.03–1.09), larger tumor diameter (12–18 mm, HR = 2.48, 95% CI = 1.40–4.42, >18 mm, HR = 6.41, 95% CI = 1.45–28.35), and protons (HR = 1.89, 95% CI = 1.06–3.37) were negative prognosticators of survival. Conclusions Patients selected for proton treatment have inferior survival outcomes compared to brachytherapy in this retrospective analysis. There may be unaccounted variables that influence survival, warranting further prospective studies.
KW - Choroid melanoma
KW - National Cancer Database
KW - Plaque brachytherapy
KW - Proton therapy
KW - Uveal melanoma
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U2 - 10.1016/j.brachy.2017.07.014
DO - 10.1016/j.brachy.2017.07.014
M3 - Article
C2 - 28966081
AN - SCOPUS:85030723489
SN - 1538-4721
VL - 16
SP - 1225
EP - 1231
JO - Brachytherapy
JF - Brachytherapy
IS - 6
ER -