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Federica Genovesi-Ebert, Maria-Grazia Fabrini, Franco Perrone, Emanuele Di Bartolo, Federica Cresti, Carlo Greco, Stanislao Rizzo; Flexible Multimodal Approach To Eye Melanoma: Patterns Of Care And Related Complications. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3269.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy and safety of a flexible radiotherapy approach for uveal malignant melanomas (UMM)
A retrospective analysis was performed on a series of 100 consecutive patients treated between 2003 and 2010 in a single institution. Main outcome measures were survival rate, enucleation rate, local tumor control, visual outcomes and complications. The treatment was planned depending on tumor size and location, using a multimodal range of options such as: brachytherapy plaque (Ruthenium 106 and/or Iodine 125), stereotactic irradiation (SRS).Brachytherapy was the treatment of choice in small- (< 3mm) and medium-sized (3 -10 mm) tumors. A 106-Ru plaque was used for T1-T2 lesions with a single administration with a prescription dose of 100-120 Gy to tumor apex. For medium-sized UMM a single fraction with a 125-I plaque was used with a prescription dose of 85 Gy to COMS point for lesions < 5 mm, and to tumor apex for larger lesions. In selected cases, two subsequent fractions with 106-Ru and a 125-I plaque were used to keep the scleral dose with acceptable toxicity levels while ensuring an optimal dose coverage. In the presence of large (>10 mm) tumors the treatment of choice was SRS with a dose of 30 Gy in a single fraction. A sequential brachytherapy treatment was performed 6 weeks after SRS with a prescription dose of 45 Gy to COMS point.Transpupillary thermotherapy and intravitreal injection of bevacizumab were used as adjunctive therapies.
Median follow-up was 35.4 months. Mean 5-year overall survival was 95.3%. Local recurrence rate 3.7%. Vision preservation achieved in 84% of cases.Treatment-related major complications occurred in 6% of cases (2 severe glaucomas, 1 scleral necrosis, 2 radiation retinopathy, 1 optic neuropathy). Enucleation was performed in 4 patients due to uncontrolled neovascular glaucoma (2 eyes) or local recurrence ( 2 cases).Tumor reduction was : large UMM 14.0 %, medium UMM 40.5 %,small UMM 66%.
The flexible approach to uveal melanomas achieves a high local tumor control rate with a low complication rate by reducing the over-irradiation of healthy tissues. The survival rates appear similar to previously published data
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