Uveal Melanoma: Brachytherapy

In 1930, Sir Foster Moore first used brachytherapy for uveal melanoma by inserting radon-222 seeds directly into the tumor (Moore, Br J Ophthalmol 14:145–152, 1930). This technique was later modified by Stallard and eventually further refined using radioactive plaques containing cobalt-60 anchored to the episcleral surface (Stallard, Br J Ophthalmol 32(9):618–639, 1948; Stallard, Br J Ophthalmol 50(3):147–155, 1966). In the United States, this radionuclide was gradually replaced by plaques loaded with iodine-125 seeds, as this provided less radiation to surrounding tissues (Sealy et al., Br J Radiol 49(582):551–554, 1976; Packer and Rotman, Ophthalmology 87(6):582–590, 1980). In Europe, the pioneering work of Lommatzsch in the 1970s led to the introduction of ruthenium-106 as a radioactive source for episcleral brachytherapy of uveal melanoma (Lommatzsch, Surv Ophthalmol 19(2):85–100, 1974). Although observational data suggested that there was no survival difference compared to patients enucleated for uveal melanoma, it had not been confirmed in a randomized control trial until the Collaborative Ocular Melanoma Study (COMS) was launched in the mid-1980s. This included patients with medium-sized uveal melanoma, who had equal 5-year and 10-year survival rates in the enucleation and iodine brachytherapy groups (Collaborative Ocular Melanoma Study Group, Arch Ophthalmol 119:969–982, 2001; Collaborative Ocular Melanoma Study Group, Arch Ophthalmol 124:1684–1693, 2006). Ever since, brachytherapy has been a mainstay treatment within this size group. Smaller tumors are generally observed for growth or in selected cases treated with transpupillary thermotherapy, while patients with larger tumors still undergo enucleation.