Skip to main content
NCBI home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1987 May;71(5):348–352. doi: 10.1136/bjo.71.5.348

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

W A Manschot, R Van Strik
PMCID: PMC1041164  PMID: 3580350

Abstract

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.

Full text

PDF
348

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barr C. C., Sipperley J. O., Nicholson D. H. Small melanomas of the choroid. Arch Ophthalmol. 1978 Sep;96(9):1580–1582. doi: 10.1001/archopht.1978.03910060214005. [DOI] [PubMed] [Google Scholar]
  2. COLLINS V. P., LOEFFLER R. K., TIVEY H. Observations on growth rates of human tumors. Am J Roentgenol Radium Ther Nucl Med. 1956 Nov;76(5):988–1000. [PubMed] [Google Scholar]
  3. Char D. H., Crawford J. B., Castro J. R., Woodruff K. H. Failure of choroidal melanoma to respond to helium ion therapy. Arch Ophthalmol. 1983 Feb;101(2):236–241. doi: 10.1001/archopht.1983.01040010238011. [DOI] [PubMed] [Google Scholar]
  4. Char D. H., Lonn L. I., Margolis L. W. Complications of cobalt plaque therapy of choroidal malanomas. Am J Ophthalmol. 1977 Oct;84(4):536–541. doi: 10.1016/0002-9394(77)90448-2. [DOI] [PubMed] [Google Scholar]
  5. Cleasby G. W., Kutzscher B. M. Clinicopathologic report of successful cobalt 60 plaque therapy for choroidal melanoma. Am J Ophthalmol. 1985 Dec 15;100(6):828–830. doi: 10.1016/s0002-9394(14)73375-6. [DOI] [PubMed] [Google Scholar]
  6. Cruess A. F., Augsburger J. J., Shields J. A., Donoso L. A., Amsel J. Visual results following cobalt plaque radiotherapy for posterior uveal melanomas. Ophthalmology. 1984 Feb;91(2):131–136. doi: 10.1016/s0161-6420(84)34317-2. [DOI] [PubMed] [Google Scholar]
  7. Ferry A. P., Blair C. J., Gragoudas E. S., Volk S. C. Pathologic examination of ciliary body melanoma treated with proton beam irradiation. Arch Ophthalmol. 1985 Dec;103(12):1849–1853. doi: 10.1001/archopht.1985.01050120083027. [DOI] [PubMed] [Google Scholar]
  8. Foerster M. H., Bornfeld N., Wessing A., Schulz U., Schmitt G., Meyer-Schwickerath G. Die Behandlung von malignen Melanomen der Uvea mit 106-Ruthenium-Applikatoren. Bericht über die ersten hundert Essener Fälle. Klin Monbl Augenheilkd. 1984 Dec;185(6):490–494. doi: 10.1055/s-2008-1054681. [DOI] [PubMed] [Google Scholar]
  9. Gass J. D. Comparison of prognosis after enucleation vs cobalt 60 irradiation of melanomas. Arch Ophthalmol. 1985 Jul;103(7):916–923. [PubMed] [Google Scholar]
  10. Gass J. D. Comparison of uveal melanoma growth rates with mitotic index and mortality. Arch Ophthalmol. 1985 Jul;103(7):924–931. doi: 10.1001/archopht.1985.01050070050028. [DOI] [PubMed] [Google Scholar]
  11. Gragoudas E. S., Goitein M., Verhey L., Munzenreider J., Urie M., Suit H., Koehler A. Proton beam irradiation of uveal melanomas. Results of 5 1/2-year study. Arch Ophthalmol. 1982 Jun;100(6):928–934. doi: 10.1001/archopht.1982.01030030936007. [DOI] [PubMed] [Google Scholar]
  12. Grizzard W. S., Torczynski E., Char D. H. Helium ion charged-particle therapy for choroidal melanoma. Histopathologic findings in a successfully treated case. Arch Ophthalmol. 1984 Apr;102(4):576–578. doi: 10.1001/archopht.1984.01040030454025. [DOI] [PubMed] [Google Scholar]
  13. Jensen O. A. Malignant melanomas of the human uvea: 25-year follow-up of cases in Denmark, 1943--1952. Acta Ophthalmol (Copenh) 1982 Apr;60(2):161–182. doi: 10.1111/j.1755-3768.1982.tb08371.x. [DOI] [PubMed] [Google Scholar]
  14. Lommatzsch P. K. beta-Irradiation of choroidal melanoma with 106Ru/106Rh applicators. 16 Years' experience. Arch Ophthalmol. 1983 May;101(5):713–717. doi: 10.1001/archopht.1983.01040010713002. [DOI] [PubMed] [Google Scholar]
  15. MacFaul P. A., Morgan G. Histopathological changes in malignant melanomas of the choroid after cobalt plaque therapy. Br J Ophthalmol. 1977 Mar;61(3):221–228. doi: 10.1136/bjo.61.3.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. MacFaul P. A. The place of radiotherapy in the treatment of uveal melanoma. Doc Ophthalmol. 1980 Dec 15;50(1):63–69. doi: 10.1007/BF00161151. [DOI] [PubMed] [Google Scholar]
  17. Manschot W. A. The natural history of uveal melanomas and its therapeutic consequences. Doc Ophthalmol. 1980 Dec 15;50(1):83–99. doi: 10.1007/BF00161154. [DOI] [PubMed] [Google Scholar]
  18. Manschot W. A., van Peperzeel H. A. Choroidal melanoma. Enucleation or observation? A new approach. Arch Ophthalmol. 1980 Jan;98(1):71–77. doi: 10.1001/archopht.1980.01020030073002. [DOI] [PubMed] [Google Scholar]
  19. Packer S., Rotman M., Salanitro P. Iodine-125 irradiation of choroidal melanoma. Clinical experience. Ophthalmology. 1984 Dec;91(12):1700–1708. doi: 10.1016/s0161-6420(84)34089-1. [DOI] [PubMed] [Google Scholar]
  20. Packer S. The management of choroidal melanoma. Arch Ophthalmol. 1984 Oct;102(10):1450–1452. doi: 10.1001/archopht.1984.01040031170011. [DOI] [PubMed] [Google Scholar]
  21. Rampen F. H. Malignant melanoma: sex differences in response to chemotherapy? Eur J Cancer Clin Oncol. 1982 Jan;18(1):107–110. doi: 10.1016/0277-5379(82)90033-5. [DOI] [PubMed] [Google Scholar]
  22. Seddon J. M., Gragoudas E. S., Albert D. M. Ciliary body and choroidal melanomas treated by proton beam irradiation. Histopathologic study of eyes. Arch Ophthalmol. 1983 Sep;101(9):1402–1408. doi: 10.1001/archopht.1983.01040020404014. [DOI] [PubMed] [Google Scholar]
  23. Seddon J. M., Gragoudas E. S., Albert D. M., Hsieh C. C., Polivogianis L., Friedenberg G. R. Comparison of survival rates for patients with uveal melanoma after treatment with proton beam irradiation or enucleation. Am J Ophthalmol. 1985 Mar 15;99(3):282–290. doi: 10.1016/0002-9394(85)90357-5. [DOI] [PubMed] [Google Scholar]
  24. Seigel D., Myers M., Ferris F., 3rd, Steinhorn S. C. Survival rates after enucleation of eyes with malignant melanoma. Am J Ophthalmol. 1979 Jun;87(6):761–765. doi: 10.1016/0002-9394(79)90349-0. [DOI] [PubMed] [Google Scholar]
  25. Shields J. A., Augsburger J. J., Brady L. W., Day J. L. Cobalt plaque therapy of posterior uveal melanomas. Ophthalmology. 1982 Oct;89(10):1201–1207. doi: 10.1016/s0161-6420(82)34658-8. [DOI] [PubMed] [Google Scholar]
  26. Thomas J. V., Green W. R., Maumenee A. E. Small choroidal melanomas. A long-term follow-up study. Arch Ophthalmol. 1979 May;97(5):861–864. doi: 10.1001/archopht.1979.01020010419001. [DOI] [PubMed] [Google Scholar]
  27. Zimmerman L. E., McLean I. W., Foster W. D. Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumour cells. Br J Ophthalmol. 1978 Jun;62(6):420–425. doi: 10.1136/bjo.62.6.420. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Zinn K. M., Stein/Pokorny K., Jakobiec F. A., Friedman A. H., Gragoudas E. S., Ritch R. Proton-beam irradiated epithelioid cell melanoma of the ciliary body. Ophthalmology. 1981 Dec;88(12):1315–1321. doi: 10.1016/s0161-6420(81)34883-0. [DOI] [PubMed] [Google Scholar]
  29. de Wolff-Rouendaal D., Oosterhuis J. A. Histology of small melanomas. Doc Ophthalmol. 1980 Dec 15;50(1):21–26. doi: 10.1007/BF00161146. [DOI] [PubMed] [Google Scholar]
  30. van Peperzeel H. A. Treatment of retinoblastoma and choroidal melanoma. A multidisciplinary approach. Int Ophthalmol. 1985 Mar;7(3-4):255–258. doi: 10.1007/BF00128374. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES