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Intraocular (Uveal) Melanoma Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Medium and Large Choroidal Melanoma

Eye-sparing radiation therapy, either by plaque brachytherapy or external beam, is the preferred option for most patients with medium-sized choroidal melanoma. Enucleation remains the standard therapy for large, choroidal melanomas and melanomas that cause severe glaucoma or invade the optic nerve.

Standard treatment options:

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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

  1. Plaque radiation therapy.[1,2,3,4]
  2. External-beam, charged-particle radiation therapy: This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.[5,6,7]
  3. Local eye-wall resection.[8,9]
  4. Combined therapy, with ablative laser coagulation or transpupillary thermotherapy to supplement plaque treatment.[10,11]
  5. Enucleation. This approach is considered primarily for diffuse melanomas or for cases in which there is extraocular extension; radiation complications or tumor recurrence may sometimes make enucleation necessary.[10]

Large choroidal melanomas

  1. Enucleation when the tumor is judged to be too large for eye-sparing approaches.

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.

References:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Char DH, Miller T, Crawford JB: Uveal tumour resection. Br J Ophthalmol 85 (10): 1213-9, 2001.
  9. 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.
  10. Seregard S, Landau I: Transpupillary thermotherapy as an adjunct to ruthenium plaque radiotherapy for choroidal melanoma. Acta Ophthalmol Scand 79 (1): 19-22, 2001.
  11. Shields JA: The expanding role of laser photocoagulation for intraocular tumors. The 1993 H. Christian Zweng Memorial Lecture. Retina 14 (4): 310-22, 1994.

    This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.

    WebMD Public Information from the National Cancer Institute

    Last Updated: September 04, 2014
    This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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