# Long-term outcome after treatment of large uveal melanoma

## TL;DR

This study compares long-term outcomes of two treatments for large uveal melanoma, finding that endoresection after radiation leads to better eye preservation and fewer cases of blindness.

## Contribution

The study provides new evidence that endoresection without additional brachytherapy offers better long-term outcomes for large uveal melanoma.

## Key findings

- Endoresection achieved 88% eye preservation and 92.9% local tumor control at 36 months.
- Endoresection reduced the risk of legal blindness and secondary enucleation compared to bi-nuclide plaque brachytherapy.
- Legal blindness occurred in 39.8% of patients at 36 months across all treatments.

## Abstract

The management of large uveal melanomas (UM) remains a significant challenge. Treatment options include radiotherapy alone or in combination with surgical interventions. This study evaluates the long-term outcomes of patients with large UM, focusing on the impact of different treatment strategies.

All consecutive patients with large UM treated at our institution primarily with an eye-salvaging approach—either bi-nuclide plaque brachytherapy (BNPB) or endoresection (ER) following neoadjuvant irradiation—between January 2014 and December 2020 were included in this study. Tumors with a thickness greater than 7.0 mm that were not suitable for ruthenium-106 plaque brachytherapy were classified as large. The primary study endpoints were the incidence of legal blindness of the affected eye at 12 and 36 months, as well as eye preservation and local tumor control at 36 months.

Overall, 194 patients underwent ER, while 204 received BNPB. At 12 and 36 months, legal blindness was documented in 25.5% and 39.8% of patients, respectively. Three years after treatment, eye preservation was achieved in 88.0% of cases, and local tumor control was observed in 92.9%. Multivariable analysis revealed a significantly lower risk of legal blindness at 12 months and secondary enucleation at 36 months in patients treated with ER without adjuvant brachytherapy.

Large UM can be effectively managed, achieving both anatomical and functional eye preservation for several years post-treatment. Among the approaches investigated, ER following neoadjuvant irradiation demonstrated the most favorable long-term outcomes, with a lower incidence of legal blindness and secondary enucleation.

The online version contains supplementary material available at 10.1007/s10792-025-03624-0.