Uveal melanoma medical therapy

Revision as of 18:00, 28 October 2015 by Simrat Sarai (talk | contribs)
Jump to navigation Jump to search

Uveal melanoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Uveal melanoma from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiography and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Uveal melanoma medical therapy On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Uveal melanoma medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Uveal melanoma medical therapy

CDC on Uveal melanoma medical therapy

Uveal melanoma medical therapy in the news

Blogs on Uveal melanoma medical therapy

to Hospitals Treating Uveal melanoma

Risk calculators and risk factors for Uveal melanoma medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

The optimal therapy for uveal melanoma depends on the size of the tumor. The various treatment modalities for uveal melanoma include enucleation, plaque brachytherapy, external beam proton therapy, transupillary thermotherapy, Gamma Knife stereotactic radiosurgery, and resection of the tumor.[1]

Medical Therapy

  • The treatment protocol for uveal melanoma has been directed by many clinical studies, the most important being "The Collaborative Ocular Melanoma Study" (COMS). The treatment of uveal melanoma varies according to location, size of the eye melanoma, and the overall health of the patient. However, chief among them is the size of the tumor.
  • Primary treatment can involve removal of the affected eye (enucleation); however, this is now reserved for cases of extreme tumor burden or other secondary problems.
  • Advances in radiation therapies have significantly decreased the number of patients treated by enucleation in developed countries. The most common radiation treatment is plaque brachytherapy, in which a small disc-shaped shield (plaque) encasing radioactive seeds (most often Iodine-125, though Ruthenium-106 and Palladium-103 are also used) is attached to the outside surface of the eye, overlying the tumor. The plaque is left in place for a few days and then removed. The risk of metastasis after plaque radiotherapy is the same as that of enucleation, suggesting that micrometastatic spread occurs prior to treatment of the primary tumor.
  • Other modalities of treatment include transpupillary thermotherapy, external beam proton therapy, resection of the tumor, Gamma Knife stereotactic radiosurgery or a combination of different modalities. Different surgical resection techniques can include trans-scleral partial choroidectomy, and transretinal endoresection.[2]

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.
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).
Offered as an alternative for large, diffuse, surgically nonresectable lesions of the iris.[1]

Standard treatment options for ciliary body melanoma

Local control rates are high, but treatment is associated with a high incidence of secondary cataract.
This approach is offered at specialized referral centers. It requires careful patient cooperation, with voluntary fixation of gaze.
This option is mainly suitable for selected ciliary body or anterior choroidal tumors with smaller basal dimension and greater thickness.
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.[1]

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.
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.[1]

Standard treatment options for medium-sized choroidal melanomas

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.[1]

Standard treatment option for large choroidal melanomas

Enucleation when the tumor is judged to be too large for eye-sparing approaches.

Standard therapy for extraocular extension and metastatic intraocular melanoma

Extrascleral extension confers a poor prognosis. For patients with gross tumor involvement of the orbit, treatment requires orbital exenteration. However, there is no evidence that such radical surgery will prolong life. Most patients with localized or encapsulated extraocular extension are not exenterated. No effective method of systemic treatment has been identified for patients with metastatic ocular melanoma. Available clinical trials should be considered as an option for these patients.[1]

Standrad therapy for recurrent intraocular melanoma

The prognosis for any patient with recurring or relapsing disease is poor, regardless of cell type or stage. The question and selection of further treatment depends on many factors, including the extent of the lesion, age and health of the patient, prior treatment, and site of recurrence, as well as individual patient considerations. Surgical resection of metastases diagnosed subsequent to initial management of ocular melanoma in single-center, case series of highly selected patients has been reported. The extent to which the occasional favorable outcomes are the result of strong selection factors is not clear, so this approach cannot be considered standard. Clinical trials are appropriate, and eligible patients should be advised to consider participation in them whenever possible. [1]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Uveal melanoma. National Cancer Institute(2015) http://www.cancer.gov/types/eye/patient/intraocular-melanoma-treatment-pdq Accessed on October 24 2015
  2. Uveal melanoma. Wikipedia(2015) https://en.wikipedia.org/wiki/Uveal_melanoma Accessed on October, 27 2015

Template:WikiDoc Sources