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
Summary
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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