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Correspondence |

Controversy Regarding Pre-enucleation Radiation for Uveal Melanoma

Devron H. Char, MD; Theodore L. Phillips, MD
Arch Ophthalmol. 2003;121(9):1346. doi:10.1001/archopht.121.9.1346.
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In their letter, Fine et al1 cite our work as an example of an incorrect conclusion based on an observational study, which the Collaborative Ocular Melanoma Study (COMS) has now corrected:"Observational data may be misleading, as illustrated by the findings of Char et al regarding pre-enucleation radiation therapy for large choroidal melanoma. These authors suggest that pre-enucleation radiation was harmful . . . ."

We are surprised at their adumbrated statement regarding our studies; we exchanged letters on pre-enucleation radiation for choroidal melanomas in the American Journal of Ophthalmology in 1989.2 At that time, we answered their question with the statement, "It is likely that patients' survival is not adversely affected by radiation; however it is almost inconceivable that pre-enucleation radiation will improve survival of these patients." Our earlier published work, on which the COMS group based their technique for pre-enucleation radiation, is similar to several other studies and the conclusion of the vastly more expensive COMS. Although we noted a correlation between radiation and worse survival in a retrospective analysis, our discussion clearly states that we felt pre-enucleation radiation did not improve survival in patients with choroidal melanoma. We offered a number of reasons why the inverse correlation between radiation and survival could have been spurious.3

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