Retrospective evaluation of patients with uveal melanoma treated by stereotactic radiosurgery with and without tumor resection

Importance: The present study intended to analyze the suitability of single-dose stereotactic radiotherapy in the treatment of uveal melanoma that cannot be handled with ruthenium-brachytherapy and therefore is a challenge for ophthalmologists concerning local tumor control, as well as preservation of the eye and visual function. Objectives: To evaluate local tumor control, eye preservation, visual course, radiation complications, metastases, and death after single-dose stereotactic radiotherapy (SDRT) applied exclusively or combined with tumor resection in uveal melanomas that are neither suitable nor favorably located for ruthenium brachytherapy. Design: Retrospective, observational case series. Setting: Primary care center. Participants: Seventy-eight patients with uveal melanoma were treated. Intervention: Between June 3, 2003, and March 18, 2008, patients with uveal melanoma received SDRT monotherapy (group 1, 60 patients) or SDRT combined with tumor resection (group 2, 18 patients). Radiotherapy was performed with a tumor-surrounding dose of 25 Gy on a linear accelerator. Main Outcome Measures: Local tumor control, eye preservation, visual results, and radiation complications. Results: Within a median follow-up of 33.7 months (range, 0.13-81.13 months), 6 recurrences occurred in group 1; none recurred in group 2. The Kaplan-Meier estimate for local control was 85% at 3 years in group 1 and 100% in group 2 (P=.22). Eye preservation rate was 77% vs 87% at 3 years (groups 1 and 2, respectively) (P=.82). Visual acuity decreased with a median loss of -18 Snellen lines (group 1) and -22 Snellen lines (group 2). More retinopathies (P=.07), opticopathies (P=.27), and rubeotic glaucomas (P=.10) occurred in group 1. No significant difference was observed in the development of metastases (P=.33). The groups differed in overall survival because of 2 deaths occurring shortly after surgery in group 2 for unexplained reasons (P=.06). Conclusions and Relevance: Survival analysis suggested that SDRT with combined tumor resection might be associated with increased tumor control and fewer radiation complications than SDRT as monotherapy. Both groups had similar eye retention rates and were comparable concerning the decrease in visual function in most eyes. However, the protocol was stopped after 3 unexplainable deaths after surgery.