Is irradiation a justifiable treatment of choroidal melanoma? Analysis of published results

• Published in: British journal of ophthalmology Vol. 71; no. 5; pp. 348 - 352
• Main Authors: Manschot, W A, Van Strik, R
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.05.1987; BMJ; BMJ Publishing Group LTD
• Subjects: Biological and medical sciences; Choroid Neoplasms - mortality; Choroid Neoplasms - pathology; Choroid Neoplasms - radiotherapy; Humans; Medical sciences; Melanoma - mortality; Melanoma - pathology; Melanoma - radiotherapy; Melanoma - secondary; Ophthalmology; Time Factors; Tumors and pseudotumors of the eye, orbit, eyelid, lacrimal apparatus; Choroid; Tumor; Eye disease; Radiotherapy; Malignant melanoma
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.71.5.348

Analysis of the literature shows that dissemination of choroidal melanomas generally occurs after the 7 mm diameter stage, that doubling times of uveal melanomas vary from 30 to 365 days, and that death from metastases occurs 30-40 doubling times after dissemination. Tumour related death within three years after therapy is caused by pre-existing metastases. Survival rates for less than four years after therapy are therefore irrelevant in evaluating the efficacy of therapeutic regimens. Considerably higher postirradiation than postenucleation death rates after a mean 10-year follow-up period have been reported, and this difference can be explained by a reported mean clinical tumour regression rate of 31% two years after irradiation and histopathological studies which revealed that 42 out of 43 irradiated melanomas contained viable tumour, while only 50% showed necrosis. The doubtful value of preserving vision does not justify the high risk of avoidable death from metastases in irradiated patients.