Photo Credit: Todorean

The following is a summary of “Favorable outcomes of patients with high-risk uveal melanoma treated with a novel LINAC-based frameless fractionated stereotactic radiosurgery,” published in the December 2024 issue of Ophthalmology by Cappelli et al. 

Researchers conducted a retrospective study to evaluate the outcomes of patients with high-risk uveal melanoma (UM) who underwent fractionated stereotactic radiosurgery (fSRS) using a novel LINAC-based frameless technique.  

They administered fSRS to all patients, delivering 50 Gy in 10 Gy/fraction every other day using a stereotactic LINAC equipped with an in-house eye localization and monitoring system. Tumor control, vision outcomes, and both acute and late toxicities were assessed.  

The results showed 23 patients with high-risk UM were included, with a median age of 64.8 years (range 37.9–85.1 years) and a median Karnofsky Performance Score (KPS) of 90 (range 70–100). Tumor characteristics included a median diameter of 13.5 mm (range 3.0–24.0 mm) and a median thickness of 5.05 mm (range 1.2–15.1 mm). Of the patients, 47.8% (n=11) had prior episcleral plaque treatment. At a median follow-up of 38 months, the local control rates were 95.6% at 1 year, 90.1% at 2 years, and 85.6% at 3 years. No significant differences were noted between treatment-naïve and patients treated with plaque. The eye preservation rate was 91.3%, with 2 patients requiring enucleation due to tumor progression or toxicity. High-grade acute adverse events included 1 patient with grade 3 eye pain. The median best-corrected visual acuity (LogMAR) was 0.5 pre-treatment (Snellen 20/63) and 1.0 post-treatment (Snellen 20/200).  

Investigators concluded the novel LINAC-based frameless fSRS demonstrated favorable local control, a manageable toxicity profile, and high eye preservation rates for high-risk UM, offering an effective alternative for patient’s ineligible for episcleral plaque brachytherapy. 

Source: ajo.com/article/S0002-9394(24)00564-6/abstract