The potential for adjuvant radiotherapy in choroidal melanoma

Controversy exists regarding the efficacy of enucleation in the management of choroidal melanoma. The effect of any form of ocular therapy on the prevalence of choroidal melanoma metastases is unknown. In a number of other systemic tumors, preoperative irradiation may lessen the occurrence of widespread disease. This type of therapeutic approach might be useful in the management of high-risk choroidal melanoma. In preliminary studies using 2,000 rad of preenucleation irradiation in patients with choroidal melanoma who have a poor prognosis, we have not observed notable morbidity. There are a number of limitations to the use of this adjunct therapy in choroidal melanoma management; however, a prospective national randomized trial of preenucleation irradiation in patients with high-risk choroidal melanoma might allow us to indirectly determine the effect of enucleation on the prevalence of choroidal melanoma metastases as well as delineate the potential role of this type of adjunct therapy in ocular melanoma.