Feras M Ghazawi, Rami Darwich, Michelle Le, Elham Rahme, Andrei Zubarev, Linda Moreau, Julia Valdemarin Burnier, Denis Sasseville, Miguel N Burnier, Ivan V Litvinov
Background In the developed countries, uveal melanoma is the most common primary intraocular malignancy in adults. Little is known about the epidemiological and geographical distribution of uveal melanoma in Canada.
Methods To determine the incidence patterns and geographical distribution of uveal melanoma cases in Canada, we conducted the first comprehensive, population-based national study of this malignancy across all Canadian provinces and territories during 1992–2010 years. We examined two independent population-based registries: the Canadian Cancer Registry and Le Registre Québécois du Cancer using corresponding International Classification of Diseases for Oncology-3rd edition codes for all histological subtypes of uveal melanoma.
Results We report that 2215 patients were diagnosed with uveal melanoma, of which 52.1% were males. The average -annual incidence rate of uveal melanoma in Canada was 3.75 cases per million individuals per year (95% CI 3.60 to 3.91). Overall, we report a steady increase in uveal melanoma incidence with an annual increase of 0.074 cases per million individuals per year. Significant differences in the incidence rates of uveal melanoma between Canadian provinces and territories were noted, where the highest crude incidence was in British Columbia and Saskatchewan with rates of 6.38 and 5.47 cases per million individuals per year, respectively.
Conclusions This work, for the first time, defines the disease burden of uveal melanoma in Canada and highlights important longitudinal, geographical and spatial differences in the distribution of uveal melanoma in Canada.
Jacquelyn M Davanzo, Elaine M Binkley, James F Bena, Arun D Singh
Background/Aim Molecular prognostication provides clinically applicable prognostic information for patients with uveal melanoma. Most ocular oncologists recommend intensive metastatic surveillance for patients with high-risk tumours. However, socioeconomic variables may limit a patient’s ability to adhere to recommended surveillance. We aim to analyse socioeconomic data from patients with uveal melanoma who underwent molecular prognostication to determine which variables influence adherence.
Methods This was a retrospective review of 107 consecutive patients who were diagnosed and treated for uveal melanoma from January 2014 to June 2015. Patients were categorised into low/unknown risk and high risk for metastasis. The low-risk group was followed with hepatic ultrasonography every 6 months. The high-risk group was followed with more frequent hepatic imaging or incorporation of hepatic CT/MRI into the surveillance protocol. Adherence to surveillance recommendations was recorded for the first 2 years following primary treatment. Socioeconomic data including age at diagnosis, baseline systemic staging, gene expression profile status, marital status, insurance, distance of primary residence, median household income and Charlson Comorbidity Index score were recorded. Frequency/modality of imaging and metastatic status were also recorded.
Results High-risk patients were more likely to develop metastasis than low-risk/unknown-risk patients (p<0.001). High-risk patients were more likely to have scans at baseline (p=0.008) and to have expected scans relative to low-risk/unknown-risk patients (p<0.001). There was no significant relationship between the likelihood of adhering to recommended surveillance and the other variables analysed.
Conclusions Prognostic risk level is a significant predictor of surveillance and remains significant after adjustment for socioeconomic variables. Adherence to surveillance recommendations for high-risk patients may translate into improved survival.
Raksha Rao, Santosh G Honavar, Vijayanand Palkonda Reddy
Background/aim To report the outcomes of retinoblastoma group E eyes with neovascular glaucoma (NVG) treated conservatively with intravenous chemotherapy and investigate factors associated with eye salvage and secondary enucleation.
Methods This is a retrospective, comparative, interventional case series. The outcome measures were life salvage, eye salvage and vision salvage.
Results Of the 37 eyes managed by intravenous chemotherapy, secondary enucleation was necessary in 21 eyes (group 1) and eye salvage was possible in 16 eyes (group 2). A comparison of both groups revealed significant difference with group 1 demonstrating greater duration of symptoms (18.8 weeks vs 5.4 weeks, p=0.016), greater intraocular pressure (IOP) at presentation (36 mm Hg vs 30 mm Hg, p=0.044), greater increase in corneal diameter (1.52 mm vs 0.50 mm, p=0.013) and the presence of sterile orbital cellulitis (9 vs 1, p=0.023). Further, the risk factors for secondary enucleation by univariate analysis were duration of symptoms >10 weeks (p=0.003), presenting IOP >26 mm Hg (p=0.045), buphthalmos (p=0.014) and sterile orbital cellulitis (p=0.023) and by multivariate analysis were age at presentation >6 months (p=0.012) and buphthalmos (p=0.017). At a mean follow-up of 20.5 months, none of the patients in either group developed systemic metastasis.
Conclusion For retinoblastoma group E eyes presenting with NVG, the chance of eye salvage with intravenous chemotherapy is better when the age at diagnosis is <6 months, duration of symptoms is <10 weeks, IOP is <26 mm Hg, and in the absence buphthalmos and sterile orbital inflammation.