Effectiveness of Treatments for Metastatic Uveal Melanoma

doi:10.1016/j.ajo.2009.01.023

American Journal of Ophthalmology

Volume 148, Issue 1, July 2009, Pages 119-127

https://doi.org/10.1016/j.ajo.2009.01.023 Get rights and content

Purpose

To evaluate and comment on published peer-reviewed literature for evidence of effectiveness of treatments for metastatic uveal melanoma.

Design

Analytical nonexperimental study of published peer-reviewed data.

Methods

Literature search and analysis of pertinent articles published between January 1, 1980 and June 30, 2008.

Results

Of 80 identified publications, 12 (15.0%) were review articles without original information, 2 (2.5%) were review articles combined with case reports, 22 (27.5%) were case reports, 16 (20.0%) were retrospective descriptive case series reports, 3 (3.75%) were pilot studies of a novel intervention, 2 (2.5%) were prospective phase I clinical trials, 8 (10.0%) were prospective phase I/II clinical trials, and 15 (18.75%) were prospective phase II clinical trials. None of the articles reported a prospective, randomized phase III clinical trial. The largest reported unselected patient groups had a median survival of 3 to 4 months after detection of metastasis, whereas the largest selected patient groups showed substantially longer median survival times.

Conclusions

Although median survival time after diagnosis of metastatic uveal melanoma tends to be substantially longer in selected patient subgroups subjected to aggressive invasive interventions than it is in unselected groups, much if not most of this apparent difference in survival is likely to be attributable to selection bias, surveillance bias, and publication bias rather than treatment-induced alteration of expected outcome. Published peer-reviewed articles do not provide compelling scientific evidence of any survival benefit of any method of treatment for any subgroup of patients with metastatic uveal melanoma.

Section snippets

Methods

The authors performed a literature search to identify all original articles on metastatic uveal melanoma that were published in peer-reviewed medical journals during the period January 1, 1980 through June 30, 2008. The first step in this search was to perform a PubMed search evaluating the terms uveal melanoma, choroidal melanoma, ciliary body melanoma, ciliochoroidal melanoma, iris melanoma, iridociliary melanoma, intraocular melanoma, and ocular melanoma. Articles dealing with laboratory

Results

A preliminary PubMed search identified 3,267 published articles on uveal melanoma during the specified interval. Of these, 557 dealt with some aspect of metastatic disease evaluation or treatment in human subjects. Review of the abstracts of these 557 articles identified 75 that dealt specifically with treatment of metastatic uveal melanoma. Examination of the list of references associated with each of these articles identified 8 additional relevant articles not identified by the

Discussion

To estimate the unbiased impact of any method of treatment on survival in metastatic uveal melanoma, investigators either must compare the survival experience of equivalent subgroups of patients identified by randomization in a prospective phase III clinical trial or, for retrospective comparisons, must know all of the important prognostic variables for survival time in the patients who were allocated to particular treatments selectively, must have evaluated all of these prognostic factors by

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Original articleEffectiveness of Treatments for Metastatic Uveal Melanoma

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Surv Ophthalmol

Can J Ophthalmol

Cancer Treat Rev

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Rev Med Interne

Can J Ophthalmol

Eur J Surg Oncol

Eur J Cancer

Eur J Surg Oncol

Eur J Cancer

Eur J Cancer

Ann Oncol

Ann Oncol

J Clin Epidemiol

Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26

Arch Ophthalmol

Treatment of uveal melanoma metastatic to the liver: a review of the M. D. Anderson Cancer Center experience and prognostic factors

Cancer

BOLD+interferon in the treatment of metastatic uveal melanoma: first report of active systemic therapy

J Exp Clin Cancer Res

Protracted survival after resection of metastatic uveal melanoma

Cancer

Pilot study of hepatic intraarterial fotemustine chemotherapy for liver metastases from uveal melanoma: a single-center experience with seven patients

Int J Clin Oncol

Survival of patients with metastases from uveal melanoma

Ophthalmology

Cytogenetics in the management of uveal melanoma: are we there yet?

Arch Ophthalmol

Hierarchy of evidence: from case reports to randomized controlled trials

Clin Orthop Relat Res

Quality of evidence about treatment for metastatic uveal melanoma

Trans Am Ophthalmol Soc

The treatment of metastatic uveal melanoma

Eur J Cancer

Uveal melanoma: natural history and treatment options for metastatic disease

Melanoma Res

[Therapy of metastatic malignant uveal melanoma]

Hautarzt

[Choroid melanoma. Adjuvant therapy in high-risk patients and new therapy approaches in the metastatic stage]

Ophthalmologe

Metastatic uveal melanoma: diagnosis and treatmentA literature review

Bull Soc Belge Ophtalmol

Regional treatment options for patients with ocular melanoma metastatic to the liver

Ann Surg Oncol

Metastatic uveal melanoma

Ophthalmol Clin North Am

Metastatic uveal melanoma

Int Ophthalmol Clin

Metastatic uveal melanoma therapy: current options

Int Ophthalmol Clin

Indications for surgical resection of metastatic ocular melanomaA case report and review of the literature

Int J Pancreatol

[Immunochemotherapy of metastatic uveal melanoma with interferon alfa-2b, interleukin-2 and fotemustine. Case reports and review of the literature]

Hautarzt

Resection of solitary metastasisApproach to palliative treatment of hepatic involvement with choroidal melanoma

Arch Ophthalmol

[Successful removal of a liver metastasis 15 years after enucleation of a choroid melanoma]

Fortschr Ophthalmol

Solitary pulmonary metastasis of choroidal malignant melanoma simulating primary lung cancer

Eur J Respir Dis

Treatment of hepatic metastases in ocular melanomaEmbolization of the hepatic artery with polyvinyl sponge and cisplatin

JAMA

Solitary metastasis of choroidal melanoma to the contralateral eyelid

Ophthal Plast Reconstr Surg

Metastatic choroidal melanoma to the contralateral orbit 40 years after enucleation

Arch Ophthalmol

[Apropos of a rare case of bilateral orbital metastasis of malignant melanoma of the choroid]

J Fr Ophtalmol

Original article
Effectiveness of Treatments for Metastatic Uveal Melanoma