Uveal melanoma medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Standard treatment options for iris melanoma | ===Standard treatment options for iris melanoma=== | ||
*Observation with careful follow-up | *Observation with careful follow-up | ||
In asymptomatic patients with stable lesions; follow-up includes serial photography. | :In asymptomatic patients with stable lesions; follow-up includes serial photography. | ||
*Local resection | *Local resection | ||
When progressive and pronounced growth is documented. | :When progressive and pronounced growth is documented. | ||
*Enucleation | *Enucleation | ||
If the tumor is not amenable to local resection (diffuse involvement of the iris, involvement of more than 50% of the iris and anterior chamber angle, intractable glaucoma, and extraocular extension). | :If the tumor is not amenable to local resection (diffuse involvement of the iris, involvement of more than 50% of the iris and anterior chamber angle, intractable glaucoma, and extraocular extension). | ||
*Plaque radiation therapy | *Plaque radiation therapy | ||
Offered as an alternative for large, diffuse, surgically nonresectable lesions of the iris | :Offered as an alternative for large, diffuse, surgically nonresectable lesions of the iris | ||
===Standard treatment options for ciliary body melanoma=== | |||
*Plaque radiation therapy | *Plaque radiation therapy | ||
Local control rates are high, but treatment is associated with a high incidence of secondary cataract. | :Local control rates are high, but treatment is associated with a high incidence of secondary cataract. | ||
*External-beam, charged-particle radiation therapy | *External-beam, charged-particle radiation therapy | ||
This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze. | :This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze. | ||
*Local tumor resection | *Local tumor resection | ||
This option is mainly suitable for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness. | :This option is mainly suitable for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness. | ||
*Enucleation This option is generally reserved for large melanomas when there is no hope of regaining useful vision. It is also indicated in the presence of intractable secondary glaucoma and extraocular extension. | *Enucleation | ||
:This option is generally reserved for large melanomas when there is no hope of regaining useful vision. It is also indicated in the presence of intractable secondary glaucoma and extraocular extension. | |||
Standard treatment options for small choroidal melanoma | ===Standard treatment options for small choroidal melanoma=== | ||
*Observation | *Observation | ||
This strategy is important for patients with an uncertain diagnosis or in whom tumor growth has not been documented. It is also used for asymptomatic patients with stable lesions (particularly elderly or debilitated patients), and patients with a tumor in their only useful eye. | :This strategy is important for patients with an uncertain diagnosis or in whom tumor growth has not been documented. It is also used for asymptomatic patients with stable lesions (particularly elderly or debilitated patients), and patients with a tumor in their only useful eye. | ||
*Plaque radiation therapy | *Plaque radiation therapy | ||
This treatment is used for small- or medium-sized uveal melanomas, amelanotic tumors, or tumors that touch the optic disc for greater than 3 clock-hours of optic disk circumference. | :This treatment is used for small- or medium-sized uveal melanomas, amelanotic tumors, or tumors that touch the optic disc for greater than 3 clock-hours of optic disk circumference. | ||
*External-beam, charged-particle radiation therapy | *External-beam, charged-particle radiation therapy | ||
This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze. | :This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze. | ||
*Gamma-knife radiation surgery | *Gamma-knife radiation surgery | ||
This treatment may be a feasible option for small-sized to medium-sized melanomas. | :This treatment may be a feasible option for small-sized to medium-sized melanomas. | ||
*Transpupillary thermotherapy | *Transpupillary thermotherapy | ||
As noted above, this approach has very limited use, but it can be used as a primary treatment or as an adjunctive method to plaque radiation therapy. | :As noted above, this approach has very limited use, but it can be used as a primary treatment or as an adjunctive method to plaque radiation therapy. | ||
*Local tumor resection | *Local tumor resection | ||
This strategy is used mainly for selected ciliary body or anterior choroidal tumors with smaller basal dimensions and greater thickness. | :This strategy is used mainly for selected ciliary body or anterior choroidal tumors with smaller basal dimensions and greater thickness. | ||
*Enucleation | *Enucleation | ||
This approach is used when severe intraocular pressure elevation is a factor. It may also be considered with small- and medium-sized melanomas that are invading the tissues of the optic nerve. | :This approach is used when severe intraocular pressure elevation is a factor. It may also be considered with small- and medium-sized melanomas that are invading the tissues of the optic nerve. | ||
Standard treatment options for medium-sized choroidal melanomas | ===Standard treatment options for medium-sized choroidal melanomas=== | ||
*Plaque radiation therapy | *Plaque radiation therapy | ||
*External-beam, charged-particle radiation therapy: This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze. | *External-beam, charged-particle radiation therapy | ||
*Local eye-wall resection | :This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze. | ||
*Local eye-wall resection | |||
*Combined therapy, with ablative laser coagulation or transpupillary thermotherapy to supplement plaque treatment. | *Combined therapy, with ablative laser coagulation or transpupillary thermotherapy to supplement plaque treatment. | ||
*Enucleation | *Enucleation | ||
Standard treatment option for large choroidal melanomas | :This approach is considered primarily for diffuse melanomas or for cases in which there is extraocular extension; radiation complications or tumor recurrence may sometimes make enucleation necessary. | ||
===Standard treatment option for large choroidal melanomas=== | |||
Enucleation when the tumor is judged to be too large for eye-sparing approaches. | Enucleation when the tumor is judged to be too large for eye-sparing approaches. | ||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} |
Revision as of 14:26, 26 October 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Medical Therapy
Standard treatment options for iris melanoma
- Observation with careful follow-up
- In asymptomatic patients with stable lesions; follow-up includes serial photography.
- Local resection
- When progressive and pronounced growth is documented.
- Enucleation
- If the tumor is not amenable to local resection (diffuse involvement of the iris, involvement of more than 50% of the iris and anterior chamber angle, intractable glaucoma, and extraocular extension).
- Plaque radiation therapy
- Offered as an alternative for large, diffuse, surgically nonresectable lesions of the iris
Standard treatment options for ciliary body melanoma
- Plaque radiation therapy
- Local control rates are high, but treatment is associated with a high incidence of secondary cataract.
- External-beam, charged-particle radiation therapy
- This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.
- Local tumor resection
- This option is mainly suitable for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness.
- Enucleation
- This option is generally reserved for large melanomas when there is no hope of regaining useful vision. It is also indicated in the presence of intractable secondary glaucoma and extraocular extension.
Standard treatment options for small choroidal melanoma
- Observation
- This strategy is important for patients with an uncertain diagnosis or in whom tumor growth has not been documented. It is also used for asymptomatic patients with stable lesions (particularly elderly or debilitated patients), and patients with a tumor in their only useful eye.
- Plaque radiation therapy
- This treatment is used for small- or medium-sized uveal melanomas, amelanotic tumors, or tumors that touch the optic disc for greater than 3 clock-hours of optic disk circumference.
- External-beam, charged-particle radiation therapy
- This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.
- Gamma-knife radiation surgery
- This treatment may be a feasible option for small-sized to medium-sized melanomas.
- Transpupillary thermotherapy
- As noted above, this approach has very limited use, but it can be used as a primary treatment or as an adjunctive method to plaque radiation therapy.
- Local tumor resection
- This strategy is used mainly for selected ciliary body or anterior choroidal tumors with smaller basal dimensions and greater thickness.
- Enucleation
- This approach is used when severe intraocular pressure elevation is a factor. It may also be considered with small- and medium-sized melanomas that are invading the tissues of the optic nerve.
Standard treatment options for medium-sized choroidal melanomas
- Plaque radiation therapy
- External-beam, charged-particle radiation therapy
- This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.
- Local eye-wall resection
- Combined therapy, with ablative laser coagulation or transpupillary thermotherapy to supplement plaque treatment.
- Enucleation
- This approach is considered primarily for diffuse melanomas or for cases in which there is extraocular extension; radiation complications or tumor recurrence may sometimes make enucleation necessary.
Standard treatment option for large choroidal melanomas
Enucleation when the tumor is judged to be too large for eye-sparing approaches.