Fractionated stereotactic re-irradiation after plaque radiotherapy (brachytherapy) failure in uveal melanoma

Local recurrence after ruthenium-106 (¹⁰⁶Ru) interventional radiotherapy (IRT) for uveal melanoma remains a therapeutic challenge. This study aimed to evaluate the efficacy and safety of fractionated stereotactic radiotherapy (fSRT) used as a salvage, globe-preserving option after failed IRT.

Patients with locally recurrent uveal melanoma previously treated with ¹⁰⁶Ru brachytherapy were retrospectively analyzed. All patients underwent transpupillary thermotherapy as first-line salvage treatment, followed by fSRT delivered with CyberKnife. Follow-up examinations were performed every 3-6 months, and inclu- ded assessment of visual acuity, intraocular pressure, ophtahlmic examination and liver ultrasound every 6 months.

Nine patients were identified. The median interval between brachytherapy and recurrence was 15.1 months, and the median follow-up after fSRT was 45.2 months. The majority (78%) of eye globes were salvaged. The most frequent toxicity was cataract (55.6%); no secondary glaucoma or distant metastases were observed.

Salvage treatment with fSRT after ¹⁰⁶Ru IRT failure provides excellent local control with acceptable toxicity. This approach represents an effective, non-invasive alternative to enucleation in selected patients with recurrent uveal melanoma.