Ocular melanoma is the most common ocular malignancy in adults. Based on the Surveillance, Epidemiology, and End Results (SEER) report, its annual incidence is as high as 6 new patients per million people in the United States. In Taiwan, there are only about 10~20 new patients per year. Local control is the primary goal of the treatment for ocular melanomas for patients without distant metastases. Historically, enucleation is the treatment of choice. However this is now reserved only for patients with large-sized ocular melanomas or other secondary problems.

Eye-preservation radiotherapies are shown to have equal local disease control, distant metastasis control, and overall survival as enucleation. The ability to treat choroidal melanomas with a linear accelerator (LINAC) through modern technology offers new possibilities. In the past decade, LINAC-based hypofractionated stereotactic radiotherapy (SRT) has been investigated as an alternative option for ocular melanomas.

In addition, charged particle therapy, including proton and helium, was well established in the most recent 30 years. Proton beam therapy is a highly precise targeting radiotherapy with the famous Bragg Peak. In reports of proton therapy worldwide, around a 95% local control rate and a 90% overall survival were achieved. Additionally, less retinopathy and cataract formation for proton therapy were reported in the 2013 ASTRO meeting (American Society for Radiation Oncology).

• Articles maintained by Dr. Wei-Heng Kao