Hope Is Paramount During Uveal Melanoma Treatment

There are treatment options for uveal melanoma that can preserve the eye and vision, depending on the location of the cancer, an expert said.

A uveal melanoma diagnosis often takes patients and their loved ones by surprise, as many people are not aware that cancers can occur in the eye, explained Dr. R. Christopher Bowen. However, treatment options and patient support systems exist to help patients live as long and as well as possible with this rare diagnosis.

“All this fear can bring us down and take us to a place that’s not a healthy environment. Having trust and hope is, in my opinion, equally as important as medical management,” Bowen, an assistant professor at Feinberg School of Medicine and doctor specializing in ophthalmic oncology at Northwestern University in Chicago, said in an interview with CURE®.

Treatment Options for Uveal Melanoma

Bowen explained that there are three different treatment options for uveal melanoma. The most common treatment method is plaque brachytherapy, which involves inserting seeds of the radioactive substance, iodine-125, into a gold shield that then emits low-dose radiation to the specific point of the cancer.

“It’s able to be very specific and focal in treating these melanomas,” Bowen said. “(This method) treats just where the tumor is.”

Another way to treat uveal melanoma is proton therapy. “That one has a very specific and unique niche because it's very good at treating large or multilobulated tumors that are not well defined or would not fit in within the shape of a plaque (brachytherapy),” Bowen explained. This type of treatment involved placing clips around the tumor and then delivering precise proton therapy.

However, while highly effective, proton and plaque brachytherapy may not be available in every cancer center.

“We’re fortunate at Northwestern Medicine as being one of the few institutions in the country to offer both these treatments,” Bowen said. “We have about a 90 to 95% local control rate with those (treatment options), so we’re very happy about that and grateful we offer those to patients.”

The final treatment option for uveal melanoma — though Bowen mentioned this is avoided, if at all possible — is removal of the eye. “That’s a last option we offer to patients, because sometimes they say, ‘Well, I’d rather just have the eye out.’ But I think with the current treatment and (research) landscape, we’re able to offer these really good treatments.”

Treatment May Affect Vision

Plaque brachytherapy and proton therapy can affect vision in varying degrees, depending on where the tumor is located, according to Bowen, who said that these therapies can be delivered very precisely, with about a 2-millimeter margin to ensure that all of the cancer is treated.

“If the tumor is far in the periphery, away from this vision center, oftentimes, people continue to have very good vision. I would expect to have some decline in vision with time, that's just due to the nature of having treatment,” Bowen said. “If the treatment is toward the back of the eye or the vision center, then I’d expect to have more of a decline in vision. But the nice thing is that we've got great treatment options as well to help people if they develop radiation retinopathy over time. To be able to help and manage these to a certain extent.”

Psychosocial Supports for This Rare Diagnosis

While many patients diagnosed with uveal melanoma may be unlikely to meet another individual with eye cancer in their day-to-day life, there are online support groups where patients and their families can talk with others who may have been through a similar experience.

When patients enter these support groups armed with knowledge about their specific disease — such as the genetic makeup of their cancer, which may help determine the risk of metastases, according to Bowen — “makes it helpful to compare apples to apples,” both with other survivors and to determine treatment plans with clinicians.

Additionally, Bowen mentioned that there are resources at Northwestern for patients with any cancer diagnosis to try integrative therapies, which have been shown to help with symptom burden. These exist in other cancer treatment centers, too, Bowen said, and are worth asking about.

Finally, Bowen closed by saying that difficult experiences, like a cancer diagnosis, help put things in perspective. That was the case for Bowen, himself, who had a family member with cancer.

“It helped me realize that as we're going through these kind of more challenging times, (we need) to realize that the moments that we spend with people are truly the most important and to really value those relationships and to take the time now to strengthen them and to treasure them,” he said.

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