Uveal Melanoma Treatment
Treatment is not always recommended for patients with uveal melanoma and depends on many factors, including the location and size of the tumour and a patients overall health. For example watchful waiting and close monitoring may be recommended for an elderly chronically ill patient who does not have any symptoms and has a small sized tumour. Otherwise uveal melanoma should be promptly treated.
What are my treatment options?
The treatment options for uveal melanoma may vary for different patients and may include a single therapy such as surgery, or a combination of therapies, such as surgery followed by radiotherapy.
Local Tumour removal
Local removal of the uveal melanoma tumour may be used only in very specific cases, such as patients who are unable to undergo brachytherapy and do not wish to undergo enucleation. This limitation is due to the need for highly skilled surgical expertise, as well as the number of complications associated with this surgery, which can affect the retina and cause internal bleeding of the eye.
Removal of the Eye
Removal of the eye is also known as enucleation. Enucleation is considered in cases where radiation therapy may be insufficient to treat the tumour, such as when the size of the uveal melanoma is particularly large, when the tumour has significant local spreading beyond the white portion of the eye (the sclera) and/ or a painful eye due to a condition called neovascular glaucoma. After the surgical site has healed, in most cases a prosthetic (artificial) eye can placed in the eye socket.
There are two main forms of radiation therapy used to treat uveal melanoma: Brachytherapy or External Beam Radiation Therapy (EBRT). Brachytherapy uses a plaque that is placed directly on the eye. In EBRT, a machine delivers the radiation treatment from outside the eye.
Brachytherapy “Plaque Therapy”
Brachytherapy is the most common form of radiotherapy used and is the most widely available.
Brachytherapy is used to deliver radiation that is confined to the tumour. There are various types of radioactive plaques with different radioactive seeds that can be used. Each type of seed differs on its ability to penetrate the tissue. The plaque will be physically placed on the eye close to the tumour. This requires an operation to position the plaque on the eye, the plaque will remain in place for up to a week and will require a second operation to remove it.
Brachytherapy may not be used when the tumour is very close to the optic disc, which is where part of the optic nerve (the nerve which allows us to see) is located, in this case External Beam Radiation Therapy may be used instead.
Brachytherapy is also not used on tumours that are too big (usually greater than 12mm thick) because the radiation can only penetrate so far. Since Brachytherapy is very precise many parts of the eye will remain unaffected while the localised radiation treatment will treat the tumour.
Although Brachytherapy is an excellent treatment for most uveal melanoma patients, it may have some consequences on your treated eye. The risk of side effects depends on the size and location of the tumour inside the eye as well as the type of radioactive plaque and the radiation dose during treatment, possible side effects may include;
• Radiation Retinopathy: damage to vessels that supply blood to the retina. This will result in some level of vision loss
• Optic Neuropathy – damage to the nerve that allows the person to see
• Other Complications – increased risk for cataracts, high eye pressure, internal bleeding of the eye and rarely, necrosis of eye tissue
• Long-term complications – poorer vision
External Beam Radiation Therapy
EBRT is also known as Teletherapy which includes charged particle irradiation (e.g. Proton Beam Radiotherapy), Stereotactic Radiotherapy, or Gamma Knife. Different types of EBRT may only be available at certain treatment centres in Australia.
EBRT uses a machine that delivers a beam of radiation to the affected part of the eye through the front of the eye only. In the case of Proton Beam Radiotherapy, an eye operation may be required to place metal clips or tags to help the machine know exactly where to deliver the beam of radiation.
EBRT is used to treat patients with medium to large sized tumours near the optic disc, where plaque cannot be placed to cover the entire tumour base because of the physical obstruction from the optic nerve. Complications of EBRT are shared with those of plaque radiotherapy, but there may be relatively higher rates
in in case of Stereotactic Radiotherapy. However, this largely depends on tumour factors, such as its location and size, and possibly the dose of radiation received.
is the use of chemicals to treat cancer. A trial of chemotherapy may be used only in patients with metastases. There is currently no optimal chemotherapy approach to treat metastases. This means that there are a number of clinical trials that are investigating which chemotherapy agent, either used alone or in combination with other agents, may be effective in treating metastases.
is the use of drugs to specifically stop different “engines” of cancer cells from continuing to signal to the cells to reproduce and grow.
is the use the patient’s immune system to attack the cancer. These therapies can active the immune system in different ways and therefore give different side effects. Some of these therapies might only be accessed on a clinical trial. Patients can speak with their oncologist about access to these options and any potential opportunities to participate in clinical trials.
Follow Up and Management
After your treatment for Uveal Melanoma you will attend regular follow up visits to make sure your Uveal Melanoma has not returned or spread
• Clinic visits with your doctor
• Blood tests
• Imaging scans
• Eye exams
• Physical exams