Comparison of Clinical Outcomes for Patients with Large Choroidal Melanoma after Primary Treatment with Enucleation or Proton Beam Radiotherapy

Abstract

<b><i>Purpose:</i></b> To evaluate survival and clinical outcome for patients with a large uveal melanoma treated by either enucleation or proton beam radiotherapy (PBRT). <b><i>Procedures:</i></b> This retrospective non-randomized study evaluated 132 consecutive patients with T3 and T4 choroidal melanoma classified according to TNM stage grouping. <b><i>Results:</i></b> Cumulative all-cause mortality, melanoma-related mortality and metastasis-free survival were not statistically different between the two groups (log-rank test, p = 0.56, p = 0.99 and p = 0.25, respectively). Eye retention of the tumours treated with PBRT at 5 years was 74% (SD 6.2%). In these patients at diagnosis, 73% of eyes had a best-corrected visual acuity (BCVA) of 0.1 or better. After 12 and 60 months, BCVA of 0.1 or better was observed in 47.5 and 32%, respectively. <b><i>Conclusion and Message:</i></b> Although enucleation is the most common primary treatment for large uveal melanomas, PBRT is an eye-preserving option that may be considered for some patients.