Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

Abstract

Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.

From Molecular Biology to Novel Immunotherapies and Nanomedicine in Uveal Melanoma

“…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].…”

Radiotherapy in Uveal Melanoma: A Review of Ocular Complications

“…Endoresection [4,51,55,[57][58][59] Intravitreal anti-VEGF and steroids [1,30,51,59,60] Endodrainage [55,57] Transpupillary Thermotherapy (TTT) [1,30,51,59,60] Exoresection [59] Tumor-Related Lipid Exudation (TRLE) Transpupillary thermotherapy (TTT) [61] Anti-VEGF therapy [62] Local resection [62] Diplopia and Strabismus…”

Current management of uveal melanoma: A review

“…The residual tumour scar is speculated to secrete pro‐inflammatory mediators and vascular endothelial growth factor (VEGF), resulting in persistent inflammation and even NVG. Complications can be managed by transpupillary thermotherapy, intravitreal injections of anti‐VEGF or steroids, or endoresection of the nidus in patients with toxic tumour syndrome 29 …”

“…Complications can be managed by transpupillary thermotherapy, intravitreal injections of anti-VEGF or steroids, or endoresection of the nidus in patients with toxic tumour syndrome. 29…”