Question explored with the scientific record
Conversation so far
- 1 treatment for ocular melanoma eye tumour
- 2 what are the chances of cancer spreading to liver after radioactive seedd sewn onto eye
- 3 will radioactive seed treatment save sight?
- 4 basic advice: eye removal versus radioactive seed?
Answered on this page ↓
basic advice: eye removal versus radioactive seed?
The short version: for eye melanoma, removing the eye and the radioactive plaque give about the same odds of surviving the cancer. The plaque's whole point is keeping the eye and some vision, and it pays for that with radiation damage.
The best comparison in this retrieval is the COMS trial, which put iodine-125 plaque against enucleation (eye removal) and found 5-year survival of 81% versus 82% [4]. That is the number that matters most, and it says the choice is not really about living longer. Enucleation is the more certain cancer operation. The plaque keeps the eye, but radiation retinopathy, optic nerve damage, and cataract are the documented price, and higher dose bought more vision loss without better tumor control [5]. If the plaque fails, the later eye removal is harder surgery with more complications than going straight to enucleation [1].
| Outcome | Plaque (seed) | Eye removal |
|---|---|---|
| 5-year survival [4] | 81% | 82% |
| 5-year local control, I-125 [5] | 91% | - |
| Eye kept, ciliary-body series [3] | 93% | 0% |
| Cataract by 5 years, Co-60 [2] | 22% | - |
These are mostly retrospective series, not randomized trials, and the retrieval is thin on direct head-to-head vision outcomes. The COMS comparison is the strongest evidence here [4].
My call: if the priority is cancer control, the two are close and eye removal is the more definitive operation; if keeping the eye and some sight matters and the tumor is small and away from the center of vision, the plaque is a reasonable trade. Confidence: moderate.
Sources used 5
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Comparison of primary and secondary enucleation for uveal melanoma
This study compares the operative course and post-operative outcomes of primary enucleation versus secondary enucleation after plaque brachytherapy for uveal melanoma, finding that secondary enucleation is technically more difficult and associated with higher complication rates.
DOI: 10.1080/01676830.2017.1337183 -
Cataractogenesis after cobalt-60 eye plaque radiotherapy
This study estimates the actuarial incidence of postirradiation cataracts and identifies prognostic factors in patients with primary posterior uveal melanoma treated by Cobalt-60 plaque radiotherapy, revealing that only 22% developed significant cataracts within five years despi…
DOI: 10.1016/0360-3016(93)90279-5 -
Management of ciliary body melanoma with iodine-125 plaque brachytherapy
A retrospective, nonrandomized case series evaluating presentation, management, and outcomes of 42 patients with ciliary body melanoma treated with iodine-125 plaque brachytherapy, showing high tumor control and eye preservation but notable radiation-related ocular morbidity.
DOI: 10.3129/i09-097 -
Choroidal melanoma treatment: a shift towards vision preservation
This narrative review surveys the evolution and current state of vision-preserving treatments for choroidal (uveal) melanoma, highlighting plaque brachytherapy, proton beam therapy, and stereotactic approaches, and discussing emerging therapies, immunotherapy, and AI-assisted ma…
DOI: 10.51329/mehdioptometry208 -
Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes
This retrospective study of 190 patients with uveal melanoma treated with iodine-125 plaque brachytherapy found that while increasing radiation doses correlated with greater visual acuity loss and radiation complications, they did not affect tumor control outcomes.
DOI: 10.1016/j.ijrobp.2014.01.026