Uveal melanoma: treatments available

Céline Giustranti
One of the key concerns is to preserve the patient’s sight. Conservative treatments, designed to destroy or remove the tumor while preserving the eyeball, primarily involve proton therapy and brachytherapy.

Proton therapy is an ultra-precise form of radiotherapy

Proton therapy, a type of radiotherapy that uses a proton beam with high ballistic precision, is ideal for treating tumors located near healthy organs, as is the case for uveal melanoma, since it helps reduce the radiation load. It is offered mainly for tumors at the back and on the equator of the eye.

This treatment first requires hospitalization and surgery to place clips outside the eye in order to locate the tumor. Whenever possible, a puncture is made with a fine needle during the surgery to better characterize the tumor biologically.

An endoresection (surgical ablation of the tumor scar tissue) is sometimes carried out after proton therapy to avoid complications, in particular neovascular glaucoma.

This therapy helps to preserve the eyeball, but unfortunately not the vision in 90% of cases. It controls the tumor locally in 95% of cases, and the risk of local recurrence, at less than 5% at 10 years, remains very low.

Brachytherapy is a technique with a long history at Institut Curie.

Brachytherapy is indicated for treating small tumors located in the front part of the eye, while protecting the eyelids and the lacrimal gland.
Physicians place a gold disc directly on the tumor, 12 mm to 20 mm in diameter, in which grains of radioactive iodine are implanted (iodine 125). The tumor is controlled locally in 95% of cases.

Surgery to treat uveal melanoma

Removal of the tumor while preserving the eyeball is possible only with certain tumors. If the tumor is too large, or in the event of recurrence or major complications with the conservation treatment, surgical removal of the eye may be required.

Physicians then implant a coral bead, onto which the eye muscles are grafted.