How Many Patients with Choroidal Melanoma Would Be Eligible for Neoadjuvant Systemic Therapy to Enable Ruthenium-106 Brachytherapy?

Background/objectives: Neoadjuvant systemic therapy may enhance ocular and visual preservation, also prolonging life in patients with choroidal melanoma. We investigated how many choroidal melanomas would be eligible for such treatment to enable Ruthenium-106 brachytherapy.

Methods: The cohort comprised 5859 patients treated for choroidal melanoma at the Liverpool Ocular Oncology Centre between 1993 and 2023.

Results: If the objective is ocular conservation, then, after excluding tumors > 16 mm in diameter, involving disc and/or more than two clock hours of angle or iris, and/or extending extraocularly, approximately 60.5%, 65.1%, and 67.6% of patients would remain eligible for neoadjuvant systemic therapy, according to whether the maximum allowable tumor thickness is 8 mm, 10 mm or 12 mm, respectively. If the objective is preservation of 20/80 vision, and if exclusion criteria also include vision worse than 20/80 and tumor extension to within 3 mm of optic disc and/or fovea, then 31.0%, 33.2% and 34.1% of tumors would remain in the three tumor-thickness groups, respectively. Chromosome 3 loss would be found in approximately 33%, 52% and 56% of tumors measuring 11-12 mm, 13-14 mm and >14 mm, respectively.

Conclusions: Based on the provided data and with effective neoadjuvant treatment, approximately two thirds of subjects with choroidal melanoma requiring enucleation could potentially become candidates for ruthenium-106 brachytherapy and as many as one third could also have the potential for preservation of useful vision.