Current and Emerging Radiotherapy Options for Uveal Melanoma

Simple Summary There are many possible options for treating uveal melanoma. These include brachytherapy using either low- or high-dose-rate sources temporarily implanted surgically with photon- or beta-emitting radionuclides, and also external-beam radiotherapy using high-energy linacs or with protons. In this review, we describe the various attributes and challenges for each radiotherapy option.Abstract What treatment options are there for patients having uveal melanoma? A randomized, prospective, multi-institutional clinical trial (COMS) showed no difference in survival between brachytherapy and enucleation for medium-sized lesions. With the obvious benefit of retaining the eye, brachytherapy has flourished and many different approaches have been developed such as low-dose-rate sources using alternate low-energy photon-emitting radionuclides, different plaque designs and seed-loading techniques, high-dose-rate brachytherapy sources and applicators, and low- and high-dose-rate beta-emitting sources and applicators. There also have been developments of other radiation modalities like external-beam radiotherapy using linear accelerators with high-energy photons, particle accelerators for protons, and gamma stereotactic radiosurgery. This article examines the dosimetric properties, targeting capabilities, and outcomes of these approaches. The several modalities examined herein have differing attributes and it may be that no single approach would be considered optimal for all patients and all lesion characteristics.