Radiation therapy: uveal tumors

Abstract

Among primary uveal tumors, uveal melanoma is the most frequently occurring malignant neoplasm, albeit much less common than skin melanoma and indeed most other cancers. Traditionally, uveal melanoma was treated by enucleation of the globe, but is now increasingly been managed by an eye-preserving option, which saves vision without compromising the life of patients. More than 90% of eyes now preserved have some form of radiotherapy; most often episcleral brachytherapy that is easily accessible at many ophthalmic centers. Conversely, teletherapy in the form of charged particle irradiation, stereotactic radiotherapy or radiosurgery is only available at a comparatively small number of centers. Radiotherapy for uveal melanoma causes significant side effects and complications, but the vast majority of patients can keep their eye with some remaining function. This is of significant benefit to the quality of life for many patients. The side effects of radiotherapy are intimately related to the size of the irradiated tumor, hence early detection and identification of tumors that need to be treated is critical to improve the functional outcome. Experience gained from treating uveal melanoma has been expanded to treat benign uveal tumors such as choroidal hemangioma and other malignant tumors such as uveal lymphoma and uveal metastasis.