In uveal melanoma, the COMS (Collaborative Ocular Melanoma Study) large tumor trial compared enucleation with pre-enucleation radiation. The medium tumor trial compared enucleation with iodine-125 brachytherapy. The key conclusion of the medium tumor trial regarding mortality was:

• A Brachytherapy had significantly lower 5-year mortality than enucleation
• B 5-year mortality from metastatic disease was equivalent between brachytherapy and enucleation ✓
• C Enucleation had significantly better local tumor control than brachytherapy
• D Brachytherapy was associated with significantly higher rates of radiation retinopathy causing vision loss

Explanation

The COMS medium tumor trial (the most important randomized trial in uveal melanoma management) demonstrated that 5-year all-cause and melanoma-specific mortality was equivalent between Iodine-125 brachytherapy and primary enucleation. This established plaque brachytherapy as the preferred eye-conserving treatment for medium-sized uveal melanomas (2.5–10 mm apical height, 16 mm base) without compromising survival. Local tumor control rates and rates of radiation complications (retinopathy, optic neuropathy) were documented as acceptable trade-offs for globe retention.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.