How Many Patients with Choroidal Melanoma Would Be Eligible for Neoadjuvant Systemic Therapy to Enable Ruthenium-106...

Area of Science:

• Ophthalmology
• Oncology
• Medical Physics

Background:

• Choroidal melanoma treatment aims to preserve ocular and visual function while prolonging survival.
• Neoadjuvant systemic therapy is a potential strategy to improve treatment outcomes.
• Ruthenium-106 brachytherapy is a localized treatment option for choroidal melanoma.

Purpose of the Study:

• To determine the proportion of choroidal melanomas eligible for neoadjuvant systemic therapy.
• To assess eligibility for Ruthenium-106 brachytherapy after considering neoadjuvant treatment.
• To evaluate the potential for ocular and visual preservation in choroidal melanoma patients.

Main Methods:

• Retrospective analysis of 5859 choroidal melanoma patients treated between 1993 and 2023.
• Exclusion criteria based on tumor diameter, involvement of optic disc/angle/iris, extraocular extension, and visual acuity.
• Analysis of tumor thickness and chromosome 3 loss in relation to treatment eligibility.

Main Results:

• Eligibility for neoadjuvant therapy for ocular conservation ranged from 60.5% to 67.6% based on tumor thickness (8-12 mm).
• Eligibility for vision preservation (20/80) ranged from 31.0% to 34.1% with stricter criteria.
• Chromosome 3 loss prevalence increased with tumor size, found in 33% to 56% of larger tumors.

Conclusions:

• Approximately two-thirds of patients requiring enucleation for choroidal melanoma could become candidates for Ruthenium-106 brachytherapy with neoadjuvant treatment.
• Up to one-third of patients may achieve preservation of useful vision.
• Neoadjuvant systemic therapy shows promise in expanding treatment options and improving outcomes for choroidal melanoma.