Therapy of Uveal Melanoma. A Review

Abstract

The aim of intraocular melanoma therapy is to achieve local tumor control, reduce the risk of metastasis development, preserve the eyeball and possibly the visual function of the eye. The choice of therapeutic approach requires a comprehensive view and individual approach to each patient with uveal melanoma. Factors considered include local finding (location, tumor size and shape, tumor activity, central visual acuity, intraocular complications), age and the patient‘s overall physical and psychological condition, as well as the patient‘s wishes. The most widely used method of uveal melanoma treatment is radiotherapy. The effect of radiation is caused by the absorption of ionizing radiation energy, the effect of radiation on the cell is manifested by cell death (depletion), or by a cytogenetic information change (mutation). Brachytherapy uses scleral applicators with radionuclide - ruthenium (Ru-106) applicators dominate in Europe and iodine (I-125) applicators in the USA. In external radiotherapy, the source of ionizing radiation is outside the patient‘s body. Both stereotactic radiosurgery and fractionated stereotactic radiotherapy are used. In the Czech Republic, treatment is carried out using Leksell gamma knife or CyberKnife, while proton therapy dominates in the world. The development of serious radiation complications (radiation retinopathy, neuropathy, neovascular glaucoma, toxic tumor syndrome, etc.) should be considered. Surgical therapy involves a variety of invasive procedures. Iridectomy is performed for iris melanoma. Anteriorly located choroidal melanomas and / or ciliary body melanomas can be resolved by transscleral resection (exoresection). For posterior choroidal melanomas, a combination of external tumor irradiation with pars plana vitrectomy is used. Enucleation is a method of choice in advanced tumors that cannot be effectively irradiated. Orbital exenteration is indicated in advanced tumors with extrabulbar spread or in relapsed tumor after previous enucleation.

Long-Term Stability of Melanocytomas With Persistent Vascular Activity Without Malignant Transformation

“…This combination of symptoms was associated with a 69% risk for growth. 7 Both patients described in this case report presented with all 3 risk factors with their lesions; however, because they were properly identified as melanocytomas of the optic disc, the decision was made to monitor the lesions closely and treat the associated vascular activity.…”

Choroidal melanoma tumor profile and treatment pattern for newly diagnosed patients at a reference public hospital in Sao Paulo, Brazil

“…In the last decades, however, radiotherapy has acquired an increasingly important role to the point of becoming the first-line modality to treat small and medium sized melanomas [14]. Chemotherapy is generally not an option as it is not efficient against this type of tumor [15,16].…”

Radiation therapy for uveal melanoma: a review of treatment methods available in 2021

“…This type of radiation is also known as photon radiation and is utilized by radiation oncologists as photon radiotherapy. Types of photon radiotherapy include plaque brachytherapy, external beam radiotherapy, or stereotactic radiotherapy [6].…”