Abstract

Purpose: To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the assessment of therapeutic response in patients with choroidal melanoma treated with brachytherapy.Materials and Methods: We performed a prospective, unicentric study which included patients with choroidal melanoma and indication for brachytherapy. Three DW-MRI examinations were proposed for each patient, one before and two after treatment. The apparent diffusion coefficient (ADC) value was calculated on DW-MRI and compared with local tumor control assessed by ophthalmologic follow-up.Results: From 07/2018 to 06/2019, 19 patients were recruited, 13 of whom underwent follow-up examinations. Patients' ages ranged from 24 to 78 years and 52.9% were male. At the ocular ultrasound, the mean tumor thickness and diameter were 6.3 and 11.5 mm, respectively. Two patients (15.4%) showed signs of tumor progression during follow-up (7 and 9 months after treatment). There was no statistically significant difference in tumor size between MR before and after treatment, however, there was a significant reduction in mean ADC in patients with progression (p = 0.02).Conclusion: DW-MRI is a promising method for monitoring patients with choroidal melanoma; reduction in the mean ADC values between pre-treatment MRI and the first post-treatment MRI may be related to the lack of response to brachytherapy and increased risk of disease progression.

Highlights

  • Despite being the most common primary intraocular tumor in adults, choroidal melanoma is a rare disease, with high morbidity and mortality [1, 2]

  • The aim of this study was to evaluate the role of diffusion-weighted MRI (DW-MRI) in the assessment of therapeutic response in patients with choroidal melanoma treated with brachytherapy

  • This prospective, single-center study, approved by the institutional research ethics committee, included patients diagnosed with choroidal melanoma and selected for brachytherapy, from July 2018 to June 2019

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Summary

Introduction

Despite being the most common primary intraocular tumor in adults, choroidal melanoma is a rare disease, with high morbidity and mortality [1, 2]. Patients who do not undergo local treatment have higher mortality in 5 years when compared to treated patients [3]. Up to 50% of patients may progress with distant metastasis regardless of the local treatment [10]. Failure in local tumor control after brachytherapy is relatively rare [11, 12], but patients who experience tumor recurrence or progression have a higher risk of developing distant metastases [13]. For this reason, it is essential to monitor these patients closely after treatment

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