Question explored with the scientific record
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- 1 treatment for ocular melanoma eye tumour
- 2 what are the chances of cancer spreading to liver after radioactive seedd sewn onto eye
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what are the chances of cancer spreading to liver after radioactive seedd sewn onto eye
The short version: liver spread is the real threat with eye melanoma, but the seed treatment neither causes it nor prevents it, and the retrieved studies don't give a clean percentage.
Uveal melanoma has a strong tendency to travel to the liver, not the lungs or bones. In one series of 48 patients with paired primary tumors and liver metastases, the median time from eye tumor to liver metastasis was 4.2 years [5]. In a small ciliary-body series, 2 of 42 patients developed liver metastases [2]. In a 190-patient plaque series, distant failure was 12% [3]. These are different populations and follow-up lengths, so they don't add up to one number.
The seed treatment is local. It controls the eye tumor; it does not treat the liver. The question of whether radiation increases spread was argued in the older literature, and one letter reported that irradiated melanomas still contained viable tumor in 94% of cases and that irradiation did not obviously increase metastasis [4]. That is an assertion from a letter, not a trial.
| Series | Patients | Liver/distant spread |
|---|---|---|
| Ciliary body, I-125 plaque [2] | 42 | 2 liver mets |
| I-125 plaque, mixed [3] | 190 | 12% distant failure |
| Paired primary + liver mets [5] | 48 | median 4.2 yr to liver |
What this retrieval cannot see: the large modern cohorts that track liver metastasis by gene expression class. Class 2 tumors regress more slowly after plaque radiation [1], and class 2 status is the known high-risk marker for liver spread, but no retrieved record gives a liver-metastasis rate by class.
My call: the seed treatment does not appear to cause liver spread, and it does not prevent it either; the risk comes from the tumor's biology, and the best predictor in these records is gene expression class, not the treatment choice. Confidence: moderate that radiation doesn't increase spread, low on any specific percentage for liver metastasis after plaque therapy.
Sources used 5
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Association between Tumor Regression Rate and Gene Expression Profile after Iodine 125 Plaque Radiotherapy for Uveal Melanoma
This multicenter retrospective cohort study investigates the relationship between tumor regression rates and gene expression profiles in uveal melanoma patients treated with iodine 125 plaque radiotherapy, finding that class 1 tumors regress more rapidly than class 2 tumors in t…
DOI: 10.1016/j.ophtha.2017.04.013 -
Management of ciliary body melanoma with iodine-125 plaque brachytherapy
A retrospective, nonrandomized case series evaluating presentation, management, and outcomes of 42 patients with ciliary body melanoma treated with iodine-125 plaque brachytherapy, showing high tumor control and eye preservation but notable radiation-related ocular morbidity.
DOI: 10.3129/i09-097 -
Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes
This retrospective study of 190 patients with uveal melanoma treated with iodine-125 plaque brachytherapy found that while increasing radiation doses correlated with greater visual acuity loss and radiation complications, they did not affect tumor control outcomes.
DOI: 10.1016/j.ijrobp.2014.01.026 -
Uveal melanoma management.
A letter defending ocular irradiation as a viable treatment for uveal melanoma and challenging the view that enucleation is distinctly superior, arguing that long-term data do not show irradiation increases metastasis and that outcomes after irradiation can be comparable to enuc…
DOI: 10.1136/bjo.73.6.476 -
Microcirculation and Tumor-Infiltrating Macrophages in Choroidal and Ciliary Body Melanoma and Corresponding Metastases
This study paired primary choroidal/ciliary body melanomas with their hepatic metastases to examine changes in tumor-infiltrating macrophages and microcirculation (loops, networks, and microvascular density) and to assess their associations with survival after metastasis.
DOI: 10.1167/iovs.03-0622