Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas

Abstract

Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery.

Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience

“…UM surgical resection can be performed solely or in combination with preoperative or adjuvant radiotherapy. The use of an adjunctive ruthenium plaque has been initially suggested as a tool to improve local control, considering the possibility that tumor cells remain in the scleral bed or along the resection edges leading to tumor recurrence [7,44,45], and it is now generally accepted that adjuvant radiation after tumor resection can reduce the incidence of both recurrences and metastases [18].…”

“…A recent study conducted by Relimpio-López et al evaluated the clinical outcomes of a combined approach (resection surgery and brachytherapy, conducted simultaneously or deferred) in management of anterior-located UM, affecting mainly the iris and ciliary body [45]. This experience included 26 patients treated with different combined techniques-exoresection followed by brachytherapy or endoscopy endoresection for ciliary body tumors-and showed them to be an effective and safe approach in selected patients, as long as strict follow-up is conducted after surgery.…”

Macular hole and vitreous hemorrhage subsequent to stereotactic hypofractionated radiotherapy for choroidal melanoma: A case report and review of the literature

“…Limited information is available on the treatment of MH and vitreous hemorrhage in eyes with choroidal melanoma. Hypofractionated stereotactic radiotherapy with 50–70 Gy in five fractions or plaque brachytherapy has recently proven sufficient to preserve the eyeball and achieve excellent local tumor control in patients with choroidal melanoma ( 28 , 30 ). Among these 11 cases we reviewed, two cases did not explicitly state whether a metastasis occurred and one case was unclear whether the macular hole developed before or after radiation treatment, but was lost to follow-up and metastatic disease was presumed.…”

Anatomical and functional outcomes after endoresection and adjuvant ruthenium brachytherapy for uveal melanoma: a single center case series

“…The use of an adjunctive ruthenium plaque has been suggested as a tool to improve local control, considering the possibility that tumor cells remain in the scleral bed or along the resection edges leading to tumor recurrence 7,39,40 . A recent study conducted by Relimpio-López et al evaluated the clinical outcomes of a combined approach (resection surgery and brachytherapy, conducted simultaneously or deferred) in management of anterior located UM, affecting mainly the iris and ciliary body 40 . This experience included 26 patients treated with different combined techniques, exoresection followed by brachytherapy or endoscopy endoresection for ciliary body tumors, showing to be an effective and safe approach in selected patients, as long as strict follow-up is conducted after surgery.…”

“…UM surgical resection can be performed solely or in combination with preoperative or adjuvant radiotherapy. The use of an adjunctive ruthenium plaque has been suggested as a tool to improve local control, considering the possibility that tumor cells remain in the scleral bed or along the resection edges leading to tumor recurrence 7,39,40 . A recent study conducted by Relimpio-López et al evaluated the clinical outcomes of a combined approach (resection surgery and brachytherapy, conducted simultaneously or deferred) in management of anterior located UM, affecting mainly the iris and ciliary body 40 .…”