Objective:

To evaluate the appropriateness of the standard brachytherapy dose for uveal melanoma and explore the potential for lower doses to improve patient outcomes, particularly in terms of reducing complications.

Key Findings:

• No significant relationship between apex dose and local recurrence rates in the 62.5 Gy to 104 Gy range, suggesting a reevaluation of dosing strategies.
• Higher doses are associated with increased ocular toxicity without improved local control, indicating a need for caution in dose escalation.
• Custom plaque designs can reduce radiation exposure to critical structures while maintaining tumor control, emphasizing the role of personalized treatment.

Interpretation:

The traditional 85 Gy dose may not be optimal for all patients, particularly those with smaller tumors, suggesting a need for individualized treatment plans that consider tumor characteristics and patient preferences.

Limitations:

• Lack of prospective randomized trials comparing reduced-dose regimens, which limits the strength of the conclusions.
• Variability in practice among ocular oncology centers regarding dose prescription, which may affect the generalizability of findings.

Conclusion:

A shift towards personalized brachytherapy dosing, informed by modern imaging and plaque design, could enhance patient outcomes by balancing tumor control with vision preservation, underscoring the need for further research in this evolving field.