Primary photodynamic therapy for small amelanotic choroidal melanomas: consecutive case series of 69 patients with at least 24-month follow-up

Abstract

AimsTo investigate the success and recurrence rates and visual outcomes in a large case series of amelanotic posterior choroidal melanomas treated by means of primary photodynamic therapy (PDT) with verteporfin.MethodsRetrospective case series from a single specialist ocular oncology centre. All patients had a clinical diagnosis of choroidal melanoma and were selected for PDT based on tumour characteristics. Included patients had at least 24 months of follow-up from initiation of treatment and all but one had not received treatment prior to PDT.Results69 patients were included. Mean tumour thickness was 1.9 mm (range 0.5–4.4), while the mean basal diameter was 6.9 mm (range 2.4–11.0). Included lesions were stage cT1a (n=66) or cT2a (n=3). The mean duration of follow-up from treatment initiation was 57 months (range 24–116 months). Seven lesions (10%) failed to respond to PDT. 10 patients (16%) experienced recurrence during follow-up. Overall success rate in this series was 75% (n=52). 83% of successfully treated patients (n=43) maintained or gained vision by final follow-up. Visual outcomes were significantly better in those patients who received PDT therapy alone in comparison to those who needed other treatments for their melanoma (Fisher’s exact test, p=0.004). Unfortunately, one patient (1.4%) in the series developed systemic metastases and died.ConclusionSelected amelanotic posterior uveal melanomas may be successfully treated with PDT with retention of good vision in the majority of cases, maintained with a mean of 57 months (minimum of 24 months) of follow-up.

Photodynamic therapy (PDT) as adjuvant treatment to brachytherapy for amelanotic choroidal melanoma

“…However, in most cases, multiple sessions of PDT were necessary to achieve complete tumour regression. 11–17…”

“…However, in most cases, multiple sessions of PDT were necessary to achieve complete tumour regression. [11][12][13][14][15][16][17] Furthermore, due to the low penetration depth, 18 PDT suffers from the same limitations as TTT in the treatment of choroidal melanoma as primary treatment.…”

Clinical impact of the worldwide shortage of verteporfin (Visudyne®) on ophthalmic care

“…Thus, although verteporfin is registered for the treatment of CNV caused by either AMD or pathologic myopia (European Medicines Agency 2020), in current practice, indications for PDT with verteporfin in ophthalmology have shifted to PCV, a particular subtype of AMD, and to off-label use for conditions such as CSC and various types of ocular haemangioma Raizada & Naik 2021). PDT is also sometimes used in choroidal melanomas (Quhill et al 2021) and retinal angiomatous proliferations (Saito et al 2012), but these conditions are rare and will therefore not be discussed in this article.…”

“…PDT is also sometimes used in choroidal melanomas (Quhill et al . 2021 ) and retinal angiomatous proliferations (Saito et al . 2012 ), but these conditions are rare and will therefore not be discussed in this article.…”

Combination of Molecule-Targeted Therapy and Photodynamic Therapy Using Nanoformulated Verteporfin for Effective Uveal Melanoma Treatment

“…Photodynamic therapy (PDT) is a potent therapeutic method for many cancers, including eye cancers, due to its advantages of minimal invasiveness, limited damage to vision, and low toxicity to normal tissue. − In PDT, a photosensitizer is noninvasively stimulated by light at a specific wavelength, and then, it transfers its absorbed photon energy to oxygen molecules to create reactive oxygen species (ROS), resulting in selective destruction of tumor cells and their surrounding vasculature to inhibit tumor growth. − PDT has been approved by the Food and Drug Administration (FDA) for different types of tumor treatment such as Barrett esophageal cancer, non-small-cell lung cancer, and squamous cell skin cancer. , Meaningfully, recent clinical studies have reported that 67–80% of choroidal melanoma (CM) can be completely regressed without affecting vision within 5 years in patients who received standard-fluence PDT, − suggesting that PDT could be an alternative method for eye cancer treatment that preserves patients’ vision by avoiding the retinopathy associated with conventional radiation treatments . However, PDT is not generally used as a primary treatment for UM in clinical practice so far, which may be attributed to the relatively low efficiency of PDT in the prevention of aggressive UM development , despite its effective tumor control in solid tumors and CM patients.…”