Radiation therapy for uveal melanoma: a review of treatment methods available in 2021

Abstract

Purpose of reviewRadiation therapy has become the standard of care for the treatment of uveal melanoma. We intend to outline the current radiation therapy methods that are employed to treat uveal melanoma. We will outline their relative benefits over one another. We will also provide some background about radiation therapy in general to accustom the ophthalmologists likely reading this review. Recent findingsFour main options exist for radiation therapy of uveal melanoma. Because the eye is a small space, and because melanomas are relatively radioresistant, oncologists treating uveal melanoma must deliver highly focused doses in high amounts to a small space. Therapies incorporating external beams include proton beam therapy and stereotactic radiosurgery. Stereotactic radiosurgery comes in two forms, gamma knife therapy and cyberknife therapy. Radiation may also be placed directly on the eye surgically via plaque brachytherapy. All methods have been used effectively to treat uveal melanoma. SummaryEach particular radiotherapy technique employed to treat uveal melanoma has its own set of benefits and drawbacks. The ocular oncologist can choose amongst these therapies based upon his or her clinical judgment of the relative risks and benefits. Availability of the therapy and cost to the patient remain significant factors in the ocular oncologist's choice.

Prognostic Biomarkers in Uveal Melanoma: The Status Quo, Recent Advances and Future Directions

“…Once the diagnosis of UM is made, the treatment will aim to treat the tumour, preserve the eye up to its best functional state possible and conserve the vision [9]. Therapeutic modalities include phototherapy (no longer recommended), different forms of radiotherapy ( 106 ruthenium brachytherapy or 125 iodine brachytherapy, proton beam therapy or stereotactic radiosurgery) and local resection after radiotherapy for selected lesions [9,[31][32][33][34][35]. Besides this, enucleation is the most adequate option for large-sized UMs and cases with advanced local disease, since it allows an enhanced local control with improved quality of life for the UM patient [9,[31][32][33][34][35].…”

“…Therapeutic modalities include phototherapy (no longer recommended), different forms of radiotherapy ( 106 ruthenium brachytherapy or 125 iodine brachytherapy, proton beam therapy or stereotactic radiosurgery) and local resection after radiotherapy for selected lesions [9,[31][32][33][34][35]. Besides this, enucleation is the most adequate option for large-sized UMs and cases with advanced local disease, since it allows an enhanced local control with improved quality of life for the UM patient [9,[31][32][33][34][35]. Interestingly, previous studies demonstrated superimposable mortality rates when comparing proton beam irradiation versus enucleation for patients with large choroidal melanomas [33].…”

Proton beam therapy

“…Ocular melanomas represent perfect model for a malignant tumor requiring high dose radiotherapy with complex dose distribution within the target volume, and PBT is recognized to be one of the main radiotherapy treatment options, as well as for other ocular tumors. [17] (Figure 3).…”

Melphalan intra-arterial chemotherapy for choroidal melanoma chemoreduction

“…The limitations of brachytherapy for such tumors stems from its inability to deliver an adequate therapeutic dose due to the need to deliver high doses to the sclera that translates into poor outcomes and severe complications. In this context, in the last decades, other treatment options such as external beam radiotherapy (EBRT), radiosurgery (Gamma Knife or linear accelerator), and proton therapy has been investigated [ 4 ].…”