31 Uveal Melanoma

Uveal Melanoma

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THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 15/04/2020

14. KEYMESSAGES

• Endoluminal HDR or LDR brachytherapy boost in superficial OC after external beam radiotherapy (50-60 Gy) is a safe and effective treatment.

• Uveal melanoma (UM) is the most common primary intraocular malignancy in adults

• The diagnosis is based on the ocular oncologist’s comprehensive clinical judgement.

• Brachytherapy is the most commonly used conservative treatment

• Ruthenium-106 and Iodine-125 are the radioisotopes most widely used. - Plaques loaded with Iodine-125 seeds can be used both for the treatment of small lesions and for the treatment of larger lesions. - Ruthenium-106 plaques, being a beta-emitter, are used for small lesions, generally with thickness less than 6 mm, with the advantage of better sparing of lens and opposite retina. However, in case of unavailability of Iodine-125, the Ru106 plaque treatment could also be considered for lesions up to 7 mm, provided that the maximum scleral dose does not exceed constraints. • Radiation retinopathy, cataract and optic neuropathy are the most common treatment-relatedmorbidity; they can be seenmonths after treatment and result in progressive visual loss in the treated area over 2-3 years. • The risk of metastasis and death increases three-fold with each increasing melanoma staging, and is about 10% for small tumours. Genetic profiling of the tumour is becoming important as a prognostic marker.

• Enucleation for recurrences or toxicity is required in about 4-6% of all patients, the majority during the first years.

15. REFERENCES

10. Bianciotto C, Shields CL, Pirondini C, Mashayekhi A, Furuta M, Shields JA. Proliferative radiation retinopathy after plaque radiotherapy for uveal melanoma. Ophthalmology. 2010;117(5):1005–1012. doi:10.1016/j. ophtha.2009.10.015 11. Brown GC, Shields JA, Sanborn G, Augsburger JJ, Savino PJ, Schatz NJ. Radiation retinopathy. Ophthalmology. 1982;89(12):1494–1501. doi:10.1016/ s0161-6420(82)34611-4 12. Browne AW, Dandapani SV, Jennelle R, et al. Outcomes of medium choroidal melanomas treated with rutheniumbrachytherapy guided by three-dimensional pretreatment modeling. Brachytherapy. 2015;14(5):718–725. doi:10.1016/j. brachy.2015.04.010 13. Caujolle JP, Paoli V, Chamorey E, et al. Local recurrence after uveal melanoma proton beam therapy: recurrence types and prognostic consequences. Int J Radiat Oncol Biol Phys. 2013;85(5):1218–1224. doi:10.1016/j.ijrobp.2012.10.005 14. ChangMY, McCannel TA. Local treatment failure after globe-conserving therapy for choroidal melanoma. Br J Ophthalmol. 2013;97(7):804–811. doi:10.1136/ bjophthalmol-2012-302490 15. Char DH, Kroll S, Phillips TL. Uveal melanoma. Growth rate and prognosis. Arch Ophthalmol.1997;115(8):1014–1018.doi:10.1001/archopht.1997.01100160184007 16. Collaborative Ocular Melanoma Study Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol. 2006;124(12):1684–1693. doi:10.1001/archopht.124.12.1684 17. Damato B, Patel I, Campbell IR, Mayles HM, Errington RD. Local tumor control after 106Ru brachytherapy of choroidal melanoma. Int J Radiat Oncol Biol Phys. 2005;63(2):385–391. doi:10.1016/j.ijrobp.2005.02.017 18. Damato B, Patel I, Campbell IR, Mayles HM, Errington RD. Visual acuity after Ruthenium(106) brachytherapy of choroidal melanomas. Int J Radiat Oncol Biol Phys. 2005;63(2):392–400. doi:10.1016/j.ijrobp.2005.02.059 19. De Caluwé A, Termote K, Van Gestel D, Van Limbergen E. Dose-response in choroidal melanoma. Radiother Oncol. 2018;127(3):374–378. doi:10.1016/j. radonc.2018.03.019 20. Dendale R, Lumbroso-Le Rouic L, Noel G, et al. Proton beam radiotherapy for uveal melanoma: results of Curie Institut-Orsay proton therapy center (ICPO). Int J Radiat Oncol Biol Phys. 2006;65(3):780–787. doi:10.1016/j.ijrobp.2006.01.020

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