This includes iris, ciliary body, choroidal, subfoveal, juxtapapillary, and circumpapillary melanomas [37], [38], [39], [40], [41], [42], [43], [44], [45] and [46]. The reported literature also includes treatment of small and JAK inhibitor large tumors as well as those with limited extrascleral extension [47], [48], [49],

[50], [51], [52] and [53]. The ABS-OOTF agreed to adopt the, 7th edition, American Joint Committee on Cancer (AJCC) eye cancer staging system for uveal melanoma for many reasons. Some examples include the COMS small, medium, and large categories only applied to choriodal melanomas without extrascleral extension; the AJCC uveal melanoma T-staging system has been shown to predict metastasis in more than 7000 cases; and the use of tumor, node, and metastasis staging brings ophthalmic oncology into the mainstream of general oncology [54], [55] and [56]. Clearly, universal staging promotes multicenter cooperation and data analysis. Therefore, rather than

describing a specific range of uveal melanoma sizes or locations, the ABS-OOTF recommends (Level 2 Consensus) that brachytherapy Selleck Anti-infection Compound Library exclusion criteria include tumors with gross (T4e or >5 mm) extraocular extension and blind painful eyes and those with no light perception vision. The ABS-OOTF recognizes that there will be instances in which alternative treatments are unacceptable, and patient preference for brachytherapy must be considered. 1. There exists a controversy (Level 3 Consensus) about treatment of certain uveal melanomas. For example, in the diagnosis of “small” AJCC T1 uveal melanomas, the ABS-OOTF recommends (Level 2 Consensus) that in the absence of thickness ≥2 mm, subretinal exudative fluid, and superficial orange pigment lipofuscin tumors, patients could be offered the alternative of “observation” for evidence of change (within 6 months), typically for documented growth before intervention [52], [57], [58] and [59]. This is particularly applicable for tumors near the fovea and optic nerve, or monocular patients in which Lck treatment is likely to cause radiation-related vision morbidity [60], [61] and [62].

Patients should also be counseled concerning the as yet unquantified, albeit small risk of metastasis related to “observation as treatment. In 2005, slotted plaques were devised with 8-mm openings [37] and [70]. In contrast to a notch, a slot allows the optic nerve sheath to enter the plaque carrier, thus more posteriorly locate the seed sources and move the target volume into a normalized position (surrounding the choroidal melanoma). It is important to note that plaque slots make dosimetry more complex. In these cases, medical physicists must locate seed sources to both “fill-in” the gap created by the slot and cover the target volume (71). Slotted plaques can be made by cutting standard size plaque shells or by special request from a local source (e.g., Trachsel Dental Studio, Rochester, MN, USA).