Who Should Receive RT Plus Vitrectomy/Silicone Oil in Uveal Melanoma?

Selecting which patients with uveal melanoma are the best candidates for brachytherapy plaque with vitrectomy and silicone oil relies on the size of the tumor. The optimal candidate is one with a tumor of 2 mm or thicker.

Tara A. McCannel, MD, PhD, lead author of a study assessing brachytherapy plus vitrectomy and silicone in uveal melanoma, broke down how to select patients for this treatment. In an interview with CancerNetwork®, she noted that those who have small tumors typically do well with a small amount of radiation. However, if the tumor is over 2 mm in size, and the patient already has poor vision, enucleation is often required.

McCannel is the director of the Ophthalmic Oncology Center at the University of California, Los Angeles (UCLA), Stein Eye Institute of the David Geffen School of Medicine at UCLA.

Transcript:

In the beginning, there was a benefit to reducing the radiation. We offered this to all [patients with melanoma], where we were going to save the eye. However, some of the patients have very small melanomas; the melanoma is under 2 mm, between 1- and 2-mm thickness. They tend to do well without anything because we have to use such little radiation to treat those small tumors. If your tumor is small—[fewer] than 2 mm—we won’t use the oil and all these techniques. If your tumor is 2 mm or thicker, we will always use the silicone oil as part of a routine because we see the benefit for the vision. If a person, though, comes and is diagnosed with a melanoma that’s large, and the vision is already very poor, we often recommend that the eye be removed in a surgery called enucleation. This is only for patients who tend to get diagnosed very late because there isn’t much benefit to try to radiate the eye, since there won’t be any vision left. We opt for removing the eye so that [patients] can recover quickly and carry on with their lives.

Reference

Rivas A, Samlowski W, McCannel TA. Unexpectedly low rate of metastasis and death among patients treated for uveal melanoma with brachytherapy, vitrectomy, and silicone oil. Cancers (Basel). 2025;17(16):2683. doi:10.3390/cancers17162683