Medium and Large Choroidal Melanoma
Charged-particle radiation therapy can be performed with a proton beam or helium ions.[15,16] Some investigators report better tumor control with helium ion irradiation than with 125 I episcleral plaque treatment in terms of local tumor control and eye retention; however, more anterior segment complications are found.[15,17]
Another radiation therapy technique occasionally employed but not as extensively studied is Gamma Knife surgery. Preliminary evidence suggests that Gamma Knife surgery may be a feasible treatment option for medium-sized choroidal melanomas.
Standard treatment options:
Tumor growth pattern is a factor in the therapeutic decision. If there is a diffuse melanoma or if there is extraocular extension, enucleation should be considered, but radiation therapy can be employed for less extensive disease.
Medium-sized choroidal melanomas
- Plaque radiation therapy: Allows eye preservation in most patients, but vision is generally reduced; probability of vision preservation after treatment is related to tumor size and location.[2,3,4,5,6,7,8,9,10,11,12,14,15,19]
- External-beam, charged-particle radiation therapy: Provides precisely focused radiation with a homogeneous dose distribution pattern and little lateral spread; requires sophisticated equipment available only at selected centers; involves patient cooperation during treatment (voluntarily fixating the eye on a particular point so the tumor is positioned properly in the radiation beam); allows for good local tumor control and reasonable retention of the treated eye for periods of as long as 10 years after treatment, according to reports.[15,16,17]
- Local eye-wall resection: Allows for good ocular retention rates and visual results; survival does not appear to be compromised.[20,21]
- Combined therapy, with ablative laser coagulation or transpupillary thermotherapy to supplement plaque treatment: Can be used to minimize recurrence; transpupillary thermotherapy can be used in conjunction with plaque radiation therapy for medium-sized and larger melanomas as an adjuvant treatment to enhance the effects of radiation therapy and to minimize damage to normal ocular tissue; the addition of laser photocoagulation to plaque radiation therapy for juxtapapillary choroidal melanoma has been reported to increase tumor control substantially; ocular side effects do occur but are usually not clinically significant.
- Enucleation: Is considered primarily if there is a diffuse melanoma or if there is extraocular extension; radiation complications or tumor recurrence may eventually make enucleation necessary.
Large choroidal melanomas
- Radiation therapy plus enucleation.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with ciliary body and choroid melanoma, medium/large size. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
- Hawkins BS; Collaborative Ocular Melanoma Study Group.: The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma: IV. Ten-year mortality findings and prognostic factors. COMS report number 24. Am J Ophthalmol 138 (6): 936-51, 2004.
- Shields CL, Shields JA, Gündüz K, et al.: Radiation therapy for uveal malignant melanoma. Ophthalmic Surg Lasers 29 (5): 397-409, 1998.
- Finger PT: Radiation therapy for choroidal melanoma. Surv Ophthalmol 42 (3): 215-32, 1997 Nov-Dec.
- Earle J, Kline RW, Robertson DM: Selection of iodine 125 for the Collaborative Ocular Melanoma Study. Arch Ophthalmol 105 (6): 763-4, 1987.
- Packer S, Stoller S, Lesser ML, et al.: Long-term results of iodine 125 irradiation of uveal melanoma. Ophthalmology 99 (5): 767-73; discussion 774, 1992.
- Finger PT, Berson A, Szechter A: Palladium-103 plaque radiotherapy for choroidal melanoma: results of a 7-year study. Ophthalmology 106 (3): 606-13, 1999.
- Karvat A, Duzenli C, Ma R, et al.: The treatment of choroidal melanoma with 198 Au plaque brachytherapy. Radiother Oncol 59 (2): 153-6, 2001.
- Finger PT, Romero JM, Rosen RB, et al.: Three-dimensional ultrasonography of choroidal melanoma: localization of radioactive eye plaques. Arch Ophthalmol 116 (3): 305-12, 1998.
- Hanna SL, Lemmi MA, Langston JW, et al.: Treatment of choroidal melanoma: MR imaging in the assessment of radioactive plaque position. Radiology 176 (3): 851-3, 1990.
- Harbour JW, Murray TG, Byrne SF, et al.: Intraoperative echographic localization of iodine 125 episcleral radioactive plaques for posterior uveal melanoma. Retina 16 (2): 129-34, 1996.
- Tabandeh H, Chaudhry NA, Murray TG, et al.: Intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma. Am J Ophthalmol 129 (2): 199-204, 2000.
- Finger PT, Iezzi R, Romero JM, et al.: Plaque-mounted diode-light transillumination for localization around intraocular tumors. Arch Ophthalmol 117 (2): 179-83, 1999.
- 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 124 (12): 1684-93, 2006.
- Diener-West M, Earle JD, Fine SL, et al.: The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma, III: initial mortality findings. COMS Report No. 18. Arch Ophthalmol 119 (7): 969-82, 2001.
- Char DH, Quivey JM, Castro JR, et al.: Helium ions versus iodine 125 brachytherapy in the management of uveal melanoma. A prospective, randomized, dynamically balanced trial. Ophthalmology 100 (10): 1547-54, 1993.
- Fuss M, Loredo LN, Blacharski PA, et al.: Proton radiation therapy for medium and large choroidal melanoma: preservation of the eye and its functionality. Int J Radiat Oncol Biol Phys 49 (4): 1053-9, 2001.
- Char DH, Kroll SM, Castro J: Ten-year follow-up of helium ion therapy for uveal melanoma. Am J Ophthalmol 125 (1): 81-9, 1998.
- Woodburn R, Danis R, Timmerman R, et al.: Preliminary experience in the treatment of choroidal melanoma with gamma knife radiosurgery. J Neurosurg 93 (Suppl 3): 177-9, 2000.
- Melia BM, Abramson DH, Albert DM, et al.: Collaborative ocular melanoma study (COMS) randomized trial of I-125 brachytherapy for medium choroidal melanoma. I. Visual acuity after 3 years COMS report no. 16. Ophthalmology 108 (2): 348-66, 2001.
- Char DH, Miller T, Crawford JB: Uveal tumour resection. Br J Ophthalmol 85 (10): 1213-9, 2001.
- Peyman GA, Juarez CP, Diamond JG, et al.: Ten years experience with eye wall resection for uveal malignant melanomas. Ophthalmology 91 (12): 1720-5, 1984.
- Seregard S, Landau I: Transpupillary thermotherapy as an adjunct to ruthenium plaque radiotherapy for choroidal melanoma. Acta Ophthalmol Scand 79 (1): 19-22, 2001.
- Shields JA: The expanding role of laser photocoagulation for intraocular tumors. The 1993 H. Christian Zweng Memorial Lecture. Retina 14 (4): 310-22, 1994.
- The Collaborative Ocular Melanoma Study (COMS) randomized trial of pre-enucleation radiation of large choroidal melanoma II: initial mortality findings. COMS report no. 10. Am J Ophthalmol 125 (6): 779-96, 1998.