Data from the Collaborative Ocular Melanoma Study (COMS)

These figures and tables are taken from COMS Reports 26 and 28.

The COMS study is the best available data for assessing a patient’s risk of metatstasis and risk of death from ocular melanoma. The key data is reproduced here, with my comments in boldface.

What are my chances of the melanoma going outside my eye to other parts of my body?

Figure 1. Time to diagnosis of first metastasis by baseline tumor size subgroup. HT indicates apical height of tumor; LBD, longest basal diameter of tumor.

This chart shows “time” on the x-axis. The y-axis shows what percentage of patients will be diagnosed with a metastasis.

There are 3 curves:

1. The blue curve is if your tumor has a “width” or “length” of greater than 16 millimeters (COMS “large, subgroup 2”).

2. The dotted curve is if your tumor is less than 16 millimeters in width or length but has a thickness or “height” of greater than 8 millimeters (COMS “large, subgroup 1” tumor).

3. The solid curve is if your tumor is less than 16 millimeters in width and has a thickness or height of less than 8 millimeters (COMS “medium” size tumor).

 

 

If the tumor gets outside of my eye, where does it tend to go?

Table 1. Sites of Metastasis by Baseline Tumor Size Subgroup for Patients With Metastasis Reported During Follow-up or at the Time of Death.

This table shows where in the body metastases tend to occur: mainly, the liver and the lungs. Patients may have multiple sites of metastasis.

 

 

What are my chances of dying from this cancer at 5 and 10 years if I have my eye taken out? What are my chances of dying from this cancer at 5 and 10 years if I have radiation?

Figure 2. Cumulative percentage of patients dead by time since enrollment and treatment arm (iodine 125 [125I] brachytherapy [n = 657] and enucleation [n = 660]). The numbers of patients at risk and censored at the end of each 1-year interval are shown below the horizontal axis. Ellipses indicate not applicable. A, Deaths from all causes. B, Deaths with histopathologically confirmed melanoma metastasis.

Panel B is the important one: the solid line is patients who received radiation, and the dotted line is patients who had their eye removed.

The x-axis is time and the y-axis is death with metastasis of the ocular melanoma.

As you can see, the curves are essentially the same. This data pertains to patients with “medium” size tumors (thickness less than 10 millimeters and length and width less than 16 millimeters) who underwent plaque radiation.

Figure 600051

If I have radiation, can you give me more information on my chances of dying from cancer at 5 and 10 years?

Figure 3. Cumulative percentage of patients dead by time since enrollment and patient age and maximum basal tumor diameter (MBTD). Treatment arms were combined to estimate cumulative percentages. The numbers of patients at risk and censored at the end of each 1-year interval are shown below the horizontal axis. Ellipses indicate not applicable. A, Deaths from all causes. B, Deaths with histopathologically confirmed melanoma metastasis.

Panel B is the important one; it shows death with ocular melanoma metastasis. These are patients who underwent plaque radiation (“medium” size tumors). The x-axis is time and the y-axis is death with metastasis of the ocular melanoma

The top dashed curve is patients greater than 60 years old and with tumor length or width greater than 11 millimeters.

The second heavier dashed line is patients less than 60 years old and with tumor length or width greater than 11 millimeters.

The third lighter dashed line is patients greater than 60 years old and with tumor length or width less than 11 millimeters.

The fourth solid line is patients less than 60 years old and with tumor length or width less than 11 millimeters.
Figure 600052

Figure 4. Adjusted cumulative rates of death with histopathologically confirmed melanoma metastasis by 5 and 10 years after enrollment within patient subgroups defined by baseline characteristics. Treatment arms were combined to estimate adjusted mortality rates. Rates in subgroups defined by patient age at baseline were adjusted for maximum basal tumor diameter (MBTD); rates in subgroups defined by MBTD were adjusted for patient age. Rates in all other subgroups were adjusted for patient age and MBTD. The vertical line for each interval indicates the adjusted cumulative rate of death with histopathologically confirmed melanoma metastasis for the total group of 1317 patients; the shaded bar shows the 95% confidence interval (CI) associated with that rate. CV indicates cardiovascular. Information required to classify patients was not available for distance from the proximal tumor border to the optic disc (n = 4), days from diagnosis to enrollment (n = 1), and tumor reflectivity (n = 7).

This diagram is complex and intimidating, but it shows death with ocular melanoma metastasis at 5 and 10 years stratified by baseline characteristics, after radiation treatment. Dr. Dahr can talk to you about your tumor’s “baseline characteristics.”

Figure 600054

 

 

 

Figure 5. Percentage of patients with specified status at the end of each year of follow-up. Treatment arms were combined. The number of patients who enrolled early enough to be followed up to the end of the specified year is shown at the top of the corresponding bar.

Here, note that some patients may over time develop a second primary tumor elsewhere in their body that is unrelated to the ocular melanoma (often prostate, lung, or breast cancer).

Figure 600055

 

 

If I have radiation how is my vision in that eye going to do?

Figure 6: This graph, from COMS report 16, shows vision outcomes over three years (36 months), as a function of baseline vision. The x-axis is time in months.

Visual outcome as a function of tumor thickness:

Visual outcome as a function of distance from the macula

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