Brachytherapy for Uveal Melanoma: Is the Dose Too High?

Lower radiation doses and personalized plaque design could balance tumor control with vision preservation.

By: Jose J. Echegaray, MD, Soumaya Bouhout, MD, Arun D. Singh, MD

Retinal Physician September 1, 2025 Vol 22, Issue September 2025 Page(s): 18-20

Clinical Report: Brachytherapy for Uveal Melanoma: Is the Dose Too High?

Overview

This report evaluates the implications of brachytherapy dosing for uveal melanoma, suggesting that lower doses may achieve comparable tumor control with reduced ocular toxicity. Evidence indicates that the traditional 85 Gy dose may be excessive, particularly for smaller tumors.

Background

Uveal melanoma is the most common primary intraocular malignancy in adults, and its treatment is critical for preserving vision. The standard brachytherapy dose of 85 Gy, established by the Collaborative Ocular Melanoma Study (COMS), aims to balance tumor control with the risk of radiation complications. However, emerging data suggest that lower doses may be equally effective, prompting a reevaluation of treatment protocols.

Data Highlights

No significant relationship was found between apex dose and local recurrence rate in the 62.5 Gy to 104 Gy range, with a weak regression slope (R²=.033, P=.397) noted in a 2025 review.

Key Findings

The COMS established 85 Gy as the standard dose for medium-sized uveal melanoma, but evidence suggests lower doses may be effective.
Studies indicate that increasing the dose by 1 Gy correlates with only a 0.14% decrease in recurrence rate (P=.336).
Low-dose regimens (e.g., 62.5 Gy) have shown local control rates comparable to COMS standards (9% vs 10.3%).
Advanced plaque designs, such as Eye Physics plaques, can reduce radiation exposure to critical structures by 40% to 50%.
Individualized 3D dosimetry is increasingly used to optimize plaque positioning and may allow for safe dose reductions.

Clinical Implications

Clinicians should consider the potential benefits of lower brachytherapy doses for uveal melanoma, especially in smaller tumors, to minimize ocular toxicity. The use of advanced plaque designs and individualized treatment planning may enhance patient outcomes while preserving vision.

Conclusion

The findings suggest a need for a paradigm shift in brachytherapy dosing for uveal melanoma, advocating for personalized treatment approaches that prioritize both tumor control and vision preservation.

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Retinal Physician