Treatment of uveal melanoma has favored radiotherapy with radioactive plaques or charged particle irradiation since the Collaborative Ocular Melanoma Study (COMS) showed no significant difference in survival between enucleation and brachytherapy for medium-sized tumors (COMS). The COMS melanoma-specific mortality rates were shown to be 10%, 18%, and 21% at 5, 10, and 12 years, respectively.1 Additionally, local tumor failure rates were reported as 10.3% at 5 years. Certain eyes were excluded from the COMS Medium Tumor Trial owing to the proximity of the uveal melanoma to the optic disc. Tumors were not eligible for enrollment in the COMS Medium Tumor Trial due to proximity to the optic nerve if the tumor was (1) touching the optic disc, or (2) within 2 mm of the optic disc and broad enough to subtend an angle of 90° or greater, drawn from the center of the optic disc. These tumors present unique difficulties in treatment with radiotherapy and pose a high risk of ocular complications. In the COMS study, 9% of patients who were otherwise eligible for study inclusion were excluded owing to tumor proximity to the disc.
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