Plaque radiotherapy for the management of uveal metastasis.
The management of uveal metastasis is focused on both the patient's systemic condition and the ocular condition. If there is evidence of systemic metastatic disease, then treatment of the nonocular and ocular metastatic tumors consists of chemotherapy, hormone therapy, immunotherapy, multiple-site radiotherapy, or observation. If there is no evidence of systemic involvement, then whole-eye treatment with chemotherapy, hormone therapy, immunotherapy, radiotherapy, or, rarely, enucleation is considered. For solitary uveal metastases, plaque radiotherapy is offered, and if the tumor is small, laser photocoagulation, resection, or thermotherapy can be used. Inactive uveal metastases are managed by periodic observation, but active uveal metastases often produce visual loss, secondary glaucoma, and pain, therefore, treatment is usually indicated. Radiotherapy is quite effective for control of most uveal metastasis. The technique of external beam radiotherapy is most often used and is delivered over a 3- to 4-week period in an outpatient setting. For those patients who fail chemotherapy, hormone therapy, immunotherapy, or external beam radiotherapy or those patients with a solitary uveal metastasis, plaque radiotherapy is an alternative method. Plaque radiotherapy is focal radiotherapy delivered to the eye in an inpatient setting over a relatively short period of approximately 3 days. Plaque radiotherapy provides satisfactory tumor control, even in eyes that fail other treatments. Side effects from plaque radiotherapy are comparable to those from external beam radiotherapy. Importantly, the plaque treatment requires less of a time commitment for these patients with a limited life expectancy.