Therapy of Uveal Melanoma. A Review

Abstract

The aim of intraocular melanoma therapy is to achieve local tumor control, reduce the risk of metastasis development, preserve the eyeball and possibly the visual function of the eye. The choice of therapeutic approach requires a comprehensive view and individual approach to each patient with uveal melanoma. Factors considered include local finding (location, tumor size and shape, tumor activity, central visual acuity, intraocular complications), age and the patient‘s overall physical and psychological condition, as well as the patient‘s wishes. The most widely used method of uveal melanoma treatment is radiotherapy. The effect of radiation is caused by the absorption of ionizing radiation energy, the effect of radiation on the cell is manifested by cell death (depletion), or by a cytogenetic information change (mutation). Brachytherapy uses scleral applicators with radionuclide - ruthenium (Ru-106) applicators dominate in Europe and iodine (I-125) applicators in the USA. In external radiotherapy, the source of ionizing radiation is outside the patient‘s body. Both stereotactic radiosurgery and fractionated stereotactic radiotherapy are used. In the Czech Republic, treatment is carried out using Leksell gamma knife or CyberKnife, while proton therapy dominates in the world. The development of serious radiation complications (radiation retinopathy, neuropathy, neovascular glaucoma, toxic tumor syndrome, etc.) should be considered. Surgical therapy involves a variety of invasive procedures. Iridectomy is performed for iris melanoma. Anteriorly located choroidal melanomas and / or ciliary body melanomas can be resolved by transscleral resection (exoresection). For posterior choroidal melanomas, a combination of external tumor irradiation with pars plana vitrectomy is used. Enucleation is a method of choice in advanced tumors that cannot be effectively irradiated. Orbital exenteration is indicated in advanced tumors with extrabulbar spread or in relapsed tumor after previous enucleation.

Prevalence of Choroidal Melanoma in a Hill Population of Northern India

“…Aim of intraocular therapy is to control tumour growth locally, so as to reduce risk of metastasis and preserving the eyeball to salvage visual function. Most frequently used treatment is radiotherapy, ruthemium (Ru-106) is commonly used in Europe and iodide (I-125) applicators in USA [57]. COMS report no.16 showed 43% to 49% of treated eyes had substantial impairment in visual acuity by 3 years after I 125 brachytherapy, defined as a loss of six or more lines of visual acuity from the pretreatment level (49% of eyes) or visual acuity of 20/200 or worse (43% of eyes) that was confirmed at the next 6-month examination [58].…”

Importance of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Imaging and Differentiation of Choroidal Melanoma: A Review

“…Thermotherapy has optimal outcomes when combined with brachytherapy, the so-called sandwich method. In the case of small melanomas, brachytherapy can be followed by photodynamic therapy, with indocyanine green accumulating in tumor tissue and participating in the photodynamic reaction as a photosensitizing agent [ 74 ].…”

“…Foveal and parafoveal sCVD and dCVD were shown to be reduced in all irradiated eyes [ 78 , 79 ]. CVD was significantly lower in all sectors (superior, inferior, temporal, and nasal) of the posterior pole [ 74 ]. A strong positive correlation was found between the radiation dose and reduction in vascular density.…”

Artesunate attenuates the tumorigenesis of choroidal melanoma via inhibiting EFNA3 through Stat3/Akt signaling pathway

“…More than one half of CM patients develop metastasis (Carvajal et al 2017 ). Over the past 20 years, despite advances in combined treatments, for example surgery, radiotherapy, and laser therapy, the overall survival of CM patients remains poor (Smit et al 2020 ; Rusňák et al 2020 ; Wong et al 2023 ). Therefore, it is necessary to continue explore the prognostic biomarkers and therapeutic targets for CM to provide more individualized therapies for a better prognosis.…”