Analysis of Secondary Primary Tumors In Patients With Uveal Melanoma Interview with:
Ines Laines MD and
Deeba Husain MD
Associate Professor Ophthalmology
Harvard Medical School
Investigator Angiogenesis Laboratory
Retina Service
Massachusetts Eye and Ear Infirmary
Boston, MA 02114 What is the background for this study? What are the main findings?

Response: Uveal melanoma (UM) is the most common malignant tumor of the eye in adults. More than half of the patients are long-term survivors. It is well established for other malignancies that cancer survivors are especially prone to developing independent second primary neoplasms (SPNs) and that their characteristics vary according to the site of the first primary tumor. Multifactorial causes seem to be involved, including environmental exposures and genetic risk factors. The relevance of the treatment modalities applied to the first tumor also seem to play a role, in particular radiation therapy, which is currently the gold-standard treatment for most uveal melanoma. This risk is most pronounced in the organs within the irradiated fields, but has also been described in sites not directly exposed to radiation. Despite growing knowledge about treatment-induced effects on the occurrence of SPNs in patients with other malignancies, data is insufficient for uveal melanoma. We present a population-based analysis of the Surveillance, Epidemiology, and End Results (SEER) database, which is a well-validated public database with a case ascertainment rate of 98%. In this study, we evaluated whether patients with UM demonstrate an increased incidence of  second primary neoplasms compared to the general population, including an analysis on whether radiation therapy is associated with a higher risk of thesesecond primary neoplasms. What should clinicians and patients take away from your report?

Response: We analyzed data of 3,976 subjects diagnosed with uveal melanoma as their first malignance, identified in SEER database from 1973 to 2011. We observed that UM patients present an 11% excess risk of developing SPNs compared to the reference population. The most common and biologically meaningful were skin melanomas and kidney tumors, but an increased risk for salivary gland and soft tissue malignancies was also identified. Radiation therapy did not seem to significantly influence the occurrence of second primary neoplasms. This can be due to the radiation modalities applied for uveal melanoma and the small volumes irradiated. Host susceptibility, namely genetic risk factors, and lifestyle profiles may be potential explanations for the observed increased risks. Our results emphasize the need for close surveillance of uveal melanoma patients. With ongoing research to improve their survival, assessing and understanding the risk of second primary neoplasms will become increasingly important in the follow-up of these patients. What recommendations do you have for future research as a result of this study?

Response: Despite being well validated and providing a large population and long follow-up for analysis, the SEER database presents inherent limitations of public available databases. For example, surgical treatment type specification is not available and some variables are lacking, such as radiotherapy dosage. Moreover, this database does not collect data on genetic and lifestyle risk factors (e.g. smoking) that are currently known to influence the risk of second primary neoplasms. Future research should consider these parameters to provide a better understanding of the rationale behind the increased risks observed in this study. Thank you for your contribution to the community.


Second primary neoplasms in patients with uveal melanoma: a SEER database analysis

Laíns, Inês et al.
American Journal of Ophthalmology , Volume 0 , Issue 0 ,
Published Online:February 29, 2016

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Ines Laines MD and Deeba Husain MD (2016). Analysis of Secondary Primary Tumors In Patients With Uveal Melanoma