Pre-enucleation external-beam radiation therapy (EBRT)

A randomized trial evaluated the role of pre-enucleation EBRT for large choroidal tumors that required enucleation. The study found that EBRT had no impact on overall survival (OS).[8,9][Level of evidence A1] A COMS trial included 1,003 patients with large choroidal melanomas (≥2 mm in height and ≥16 mm in diameter, or ≥10 mm in height irrespective of diameter, or ≥8 mm in height and border <2 mm from the optic disc) with no known metastases. Patients were randomly assigned to receive enucleation alone or enucleation after preoperative external photon-beam radiation from cobalt 60 or accelerators (20 Gy in 5 daily fractions) to the orbit and globe.[8,9] Through 10 years of follow-up, the median survival in both arms was approximately 7 years, and the 10-year all-cause mortality rate was 61% in both arms (relative risk [RR]death, 1.00; 95% confidence interval [CI], 0.85–1.18). Metastasis-free survival was also nearly identical in both arms.