Episcleral Plaque Brachytherapy For Uveal Melanoma

Abstract

Treatment of uveal melanomas with enucleation surgery has been the primary method for more than 100 years. The Collaborative Ocular Melanoma Study (COMS) demonstrated in 2001 that globe-sparing episcleral brachytherapy for uveal melanoma was a safe and an effective method and there was no difference in survival rates compared with enucleation therapy. Consequently, plaque brachytherapy has become the most commonly used method to preserve the eye and vision in uveal melanomas. In this review, methods that maximize vision preservation, local tumor destruction and metastasis-free survival rates are presented. These methods include medical physics and radiation therapy techniques that improve treatment results and minimize risks. Emphasis is given to plaque selection based on intraocular radiation distribution, tumor size and intraocular location. Pre-treatment dosimetry based plaque selection offers an effective way to maximize vision and improve local control. Key definitions and concepts are provided to allow for a better understanding of plaque management, strategies and associated risks.