Abstract
Brachytherapy has evolved as the treatment of choice for choroidal melanoma. Application of brachytherapy in the treatment of choroidal melanoma has expanded to encompass tumors of all sizes (including small and large) and locations (including juxtapapillary). Brachytherapy treatment is aided by enhanced tumor localization (best exemplified by intraoperative echographic localization). Brachytherapy local tumor control now approaches 99%. Brachytherapy treatment is associated with radiation complications, including retinopathy and maculopathy, in almost all patients. Early use of anti-vascular endothelial growth factor (VEGF) has been associated with enhanced retention of visual function. Current research is focused on decreasing treatment morbidity by considering lowered radiation dose (alternative isotopes, lowered planned dose delivery, enhanced localization with smaller treatment margins, radiation shielding agents), combined treatment applications (supplemental laser, anti-VEGF, vitrectomy), and personalized medicine (using tumor molecular genetic markers). Currently, brachytherapy for choroidal melanoma achieves tumor control and globe conservation in over 90% of tumor eyes.