In choroidal melanoma, the Collaborative Ocular Melanoma Study (COMS) for medium-sized tumors (2.5-10 mm apical height, ≤ 16 mm basal diameter) demonstrated that:
- A Pre-enucleation external beam radiation before enucleation reduced metastatic mortality compared to enucleation alone
- B I-125 brachytherapy achieved equivalent 5-year and 12-year survival to enucleation, establishing plaque radiotherapy as the standard for medium tumors ✓
- C Proton beam radiotherapy was superior to both enucleation and plaque radiotherapy for local control
- D Adjuvant systemic chemotherapy with dacarbazine improved overall survival when combined with enucleation
Explanation
The Collaborative Ocular Melanoma Study (COMS) was a randomized controlled trial that enrolled thousands of patients over two decades. For medium-sized choroidal melanoma, the COMS medium tumor trial demonstrated equivalent 5-year survival rates of approximately 81% for both I-125 plaque brachytherapy and enucleation. At 12-year follow-up, this equivalence was maintained. This landmark finding established iodine-125 brachytherapy as the preferred standard of care for medium choroidal melanoma, allowing eye and vision preservation without compromising survival. For the large tumor trial, pre-enucleation radiation did not improve survival compared to enucleation alone. Small tumors (< 2.5 mm height, < 10 mm diameter) were observed in a separate arm.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.