Radiotherapy in Uveal Melanoma: A Review of Ocular Complications

Abstract

Uveal melanoma represents the most prevalent form of primary malignant intraocular tumor in adults. Historically, enucleation was considered the gold-standard approach in the treatment of uveal melanoma. Currently, radiotherapy is the most commonly used therapy, aiming at a better quality of life. However, radiotherapy can result in several ocular complications, some of which may be vision-threatening. Radiation-induced dry eye, scleral necrosis, cataract, rubeosis iridis, neovascular glaucoma, radiation retinopathy, maculopathy, and optic neuropathy are the most common complications. This article aims to summarize the current literature regarding the ocular complications after radiotherapy, as well as their clinical features, risk factors, and management strategies. A thorough understanding of these issues is crucial for ophthalmologists and oncologists to provide optimal patient care, improve visual outcomes, and minimize long-term complications.

A Case of Circumscribed Choroidal Hemangioma Treated With Proton Beam Therapy and Followed Up for 15 Years

“…Additionally, it has been reported that the lower the exposure dose to the lens, the more likely the cataract will be mild [ 16 ]. There is also a report that most cataracts after proton beam therapy for choroidal hemangioma, which was irradiated avoiding lens, were mild and did not require treatment [ 7 ].…”

From Molecular Biology to Novel Immunotherapies and Nanomedicine in Uveal Melanoma

“…The most comprehensive conservative approach involves episcleral brachytherapy or charged-particle radiotherapy. These methods have demonstrated excellent local control, with a recurrence rate and distant metastasis of about 5% to 20% over five years and survival rates comparable to those of enucleation [5,25,26]. In the recent evolution of intraocular melanoma treatment, there has been a significant shift away from enucleation.…”

“…Instead, methods such as brachytherapy (iodine-125, ruthenium-106, palladium-103, or cesium-131 plaque brachytherapy), proton beam radiotherapy, stereotac-tic irradiation or radiation surgery (LINAC, Gamma Knife, CyberKnife), transcleral local resection, transretinal resection, vitreoretinal (VR) surgery, and diode laser phototherapy have taken precedence. Radiotherapy, phototherapy, and local tumor resection are also often used in combination [5,[27][28][29][30]. Radiation therapy is currently the most used technique for the treatment of UM, with brachytherapy isotope plaques emitting gamma radiation being used in most ophthalmology centers [31,32].…”

“…Over the past few decades, mortality rates have remained stagnant, exceeding 40% for patients who develop systemic diseases and succumb within a decade of diagnosis. Upon metastasis of the disease, life expectancy diminishes to less than one year [4][5][6].…”

Heterogeneity and molecular landscape of melanoma: implications for targeted therapy

“…Based on the diverse findings outlined in this study, it is possible to present the following comprehensive classification of therapeutic approaches for the treatment of melanoma. These findings shed light on potential methods that merit careful consideration in addressing this particular medical condition [28]. Local Treatments containing, Uveal melanoma Radiotherapy [29], Transpupillary Thermotherapy (TTT), Surgical Interventions including Enucleation [30][31][32] and Resection of Tumor [33][34][35][36], Emerging Approaches by Photodynamic Therapy (PDT) [37][38][39], and Local Drug Delivery [40,41], Systemic Therapies containing Targeted Therapies [42][43][44] and Immunotherapies [45,46].…”