Is It Possible to Preserve Vision without Compromising Metastases-Free Survival by Use of Fully Fractionated Stereotactic Radiotherapy for Posterior Choroidal Melanoma?

Claire E. Phillips, Arkan Youssef, Mathias Bressel, Rod O'Day, Joseph Sia, John D. McKenzie, Daniel McKay, William Campbell, Fred Kuanfu Chen

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Stereotactic radiotherapy (SRT) is used for choroidal melanoma (CM) abutting the optic nerve. Visual acuity (VA) deterioration to ≤6/60 is common. We report a pilot study of reduced-dose SRT using 2 Gy/day, aiming to preserve vision without compromising survival. Method: 60 Gy SRT was delivered in 30 fractions over 6 weeks. Liver metastasis surveillance was annual ultrasound. The primary endpoint was 5-year metastasis-free survival (5yMFS). Secondary endpoints were 2-year freedom from local progression (2yFFLP), VA, enucleation rate, and radiation toxicity. Results: Twenty adults aged ≤70 years with T1-T2M0 CM without diabetes mellitus were enrolled. Median followup was 5.1 years. About 85% and 90% of tumours were ≤3 mm of the macula and optic disc, respectively. Median tumour height was 2.2 mm (range 1.0.4.4 mm), and median basal diameter was 8.2 mm (range: 4.3.15.0 mm). 5yMFS was 88% (95% CI: 61.97), and the 2yFFLP rate was 90% (95%: CI 66.97). There were three enucleations for disease progression. Final VA in retained eyes was ≤6/7.5 in 6 (30%), 6/9 to 6/12 in 5 (25%), 6/15 to 6/48 in 2 (10%), and ≤6/ 60 in 4 (20%) eyes. Retinopathy was the main cause of vision loss besides tumour progression. Conclusion: Meaningful vision was preserved 5 years after SRT, despite high-risk tumour locations for vision loss. 2yFFLP and 5yMFS were acceptable. This dose fractionation warrants further investigation. c 2024 S. Karger AG, Basel.

Original languageEnglish
Pages (from-to)72-79
Number of pages8
JournalOcular Oncology and Pathology
Volume10
Issue number2
Early online date26 Feb 2024
DOIs
Publication statusPublished - 1 Jun 2024

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