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Radiotherapy may preserve eyes with large uveal melanomas

Last Updated: 2006-06-20 12:26:50 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Even when uveal melanomas are very large or lie close to the optic nerve, proton beam radiotherapy (PBRT) may be an option to preserve the eye in carefully selected patients.

According to Dr. Joan M. O'Brien of the University of California, San Francisco, and her associates, survival outcomes for patients treated with radiotherapy for smaller uveal melanoma are on a par with that of patients who undergo enucleation.

In the June issue of the Archives of Ophthalmology, her group reports on the results of 21 patients with extra-large uveal melanomas treated with PBRT between March 1997 and May 2002. The patients had been referred for ocular conservation treatment after they refused enucleation.

The researchers note that to their knowledge, "no other published studies have specifically evaluated PBRT for extra-large uveal melanoma treatment."

To be included in this respectively study, the tumors had to "measure at least 10 in maximum thickness or 20 mm in maximum basal diameter or be located within 3 mm of the optic nerve measuring at least 8 mm in maximum thickness or 16 mm in maximum basal diameter."

The subjects, ages 24 to 92 years, were treated with a total dose of 5600cGy delivered in four fractions, which is the upper limit of the dose that the eye can reasonably tolerate. Median follow-up was 28 months.

The complications that occurred included lash loss, dry eye/keratopathy, cataract, neovascular glaucoma, serous retinal detachment, radiation papillopathy and radiation retinopathy. None of the patients experienced radiation scleral necrosis or vitreous hemorrhage.

Local control at 24 months was 67% and ocular retention was 54%. Ten patients ended up requiring enucleation. Three patients died between 14 and 28 months due to metastatic disease in two cases and an unrelated cause in the third.

On average, the patients who avoided enucleation had lost four lines of visual acuity on the Snellen scale, but four patients gained an average of four lines.

"In certain patients unwilling to undergo primary eye removal, PBRT may offer an alternative with the possibility of retaining the eye and some vision," Dr. O'Brien and her colleagues conclude.

Arch Ophthalmol 2006;124:838-843.

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