Introduction

Clinical management of eye cancers requires precise intervention. Recent data regarding uveal melanoma treatment outcomes suggests a significant disparity between common therapeutic modalities. While clinicians often use Transpupillary thermotherapy (TTT) for small lesions, its long-term efficacy as a primary treatment is under intense scrutiny. A comprehensive retrospective study spanning 12 years at St. Erik Eye Hospital now provides clarity on this issue.

Improving Uveal Melanoma Treatment Outcomes

The study evaluated 850 patients divided into three cohorts based on their primary treatment: TTT alone, plaque brachytherapy combined with TTT, and plaque brachytherapy alone. Long-term local recurrence-free survival rates at 15 years were strikingly different. Patients receiving TTT alone showed only an 8% recurrence-free survival rate. In contrast, those treated with brachytherapy alone maintained an 86% rate. Moreover, the combined approach sat in the middle at 34%.

Furthermore, the risk of extraocular extension (EXE) was notably higher in the TTT-only group at 8.6%. This is a stark comparison to the 0% risk observed in the brachytherapy-only group. Consequently, this failure in local control translated into higher mortality rates. Patients in the TTT cohort experienced a 38% melanoma-related mortality rate at 15 years, significantly exceeding the 11% observed in the brachytherapy group.

Clinical Implications

These findings indicate that TTT alone is insufficient for reliable local control. Although TTT remains useful as an adjunct to other therapies, plaque brachytherapy remains the gold standard for preserving both life and sight. Clinicians should prioritize modalities that offer robust protection against recurrence and extraocular spread. In addition, the study reinforces the need for lifelong monitoring of patients, regardless of the initial treatment choice.

Frequently Asked Questions

Is TTT still recommended for uveal melanoma?

Current evidence suggests that while TTT may be an adjunct, it should generally not be used as monotherapy due to high recurrence and mortality risks compared to brachytherapy.

What is the risk of extraocular extension with TTT?

Research indicates an 8.6% risk of extraocular extension in patients treated with TTT alone, whereas this risk is virtually zero with plaque brachytherapy.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Fili M et al. Long-Term Local Control and Mortality After Transpupillary Thermotherapy of Small Uveal Melanomas. Clin Exp Ophthalmol. 2026 May 08. doi: 10.1111/ceo.70126. PMID: 42104514.

Shields CL et al. Primary transpupillary thermotherapy for small choroidal melanoma in 256 consecutive cases: outcomes and limitations. Ophthalmology. 2002;109(2):225-234.

Collaborative Ocular Melanoma Study (COMS) Group. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma. Arch Ophthalmol. 2006;124(12):1684-1693.