Enucleation following brachytherapy for uveal melanoma: causes and clinicopathological correlations

    Abstract

    Original article

    Enucleation following brachytherapy for uveal melanoma: causes and clinicopathological correlations

    E.S. Bulgakova, A.S. Alexeev, V.V. Roslavtseva, D.P. Volodin, A.V. Shatskikh, A.D. Matyaeva

    S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation

    Relevance. Uveal melanoma is a malignant tumor of the uveal tract of the eye, with a highly unfavorable prognosis in cases of metastasis. Brachytherapy is the main eye-preserving treatment for uveal melanoma. However, in some cases, continued tumor growth or radiation-induced complications lead to secondary enucleation. The literature contains only a limited number of studies comparing clinical and instrumental findings with histological data in patients who underwent enucleation after brachytherapy for uveal melanoma. Additionally, published data on survival rates, metastasis frequency, and event-free survival in this patient group remain scarce.

    Purpos. To analyze the causes of secondary enucleation in patients treated with brachytherapy for uveal melanoma.

    Material and methods. A retrospective analysis was conducted on 63 patients (3.9%) out of 1615 treated with brachytherapy from 1999 to 2023 at the S. Fyodorov Eye Microsurgery Federal State Institution. Clinical and instrumental findings, tumor characteristics, complications, histological results, and survival data were assessed. Statistical analysis included descriptive methods, Kaplan – Meier survival curves, and logistic regression. Secondary glaucoma was noted in 41%, but directly led to enucleation in 27% of cases. Clinical and histological assessments of tumor regression differed in 17% of cases. Metastases occurred in 12.5% of patients; 5- and 10-year event-free survival rates were 90% and 85%, respectively.

    Results. Enucleation was due to tumor progression (43%), complications (40%), and their combination (17%). The mean interval between brachytherapy and enucleation was 45 months. Viable tumor cells were histologically confirmed in 68% of cases; complete tumor regression was seen in 17%. Extraocular extension occurred in 32%, with significant association in tumors >14.1 mm in length.

    Conclusion. Secondary enucleation after brachytherapy does not worsen overall prognosis. Organ-preserving treatment remains a viable option even for larger tumors. Early post-treatment follow-up and further studies on clinicopathological correlations are essential.

    Key words: uveal melanoma, brachytherapy, enucleation, complications, survival, choroidal melanoma

    For citation: Bulgakova E.S., Alexeev A.S., Roslavtseva V.V., Volodin D.P., Shatskikh A.V., Matyaeva A.D. Enucleation following brachytherapy for uveal nelanoma: causes and clinicopathological correlations. Fyodorov Journal of Ophthalmic Surgery. 2025;2s(145): 19–26.

    DOI: 10.25276/0235-4160-2025-2S-19-26

    Corresponding author: Valeriya V. Roslavtseva, valeriarosl@yandex.ru