Gamma Knife Radiosurgery for Uveal Melanoma: Our Experience and Thematic Review

Background: Various therapies ranging from plaque brachytherapy to enucleation have been applied in uveal melanomas (UM). A gamma knife (GK) is the gold standard modality for head and neck radiation therapy with enhanced precision owing to the paucity of moving parts. The literature on GK usage in UM is rich with the methodology and nuances of GK applications undergoing constant change. Objectives: This article reports on the authors’ experience in using GK for tackling UM followed by a thematic review of the evolution of GK therapy for UM. Materials and Methods: Clinical and radiological data of patients with UM treated with GK at the All India Institute of Medical Sciences, New Delhi, from March 2019 to August 2020 was analyzed. A systematic search for comparative studies and case series evaluating GK usage in UM was performed. Results: Seven UM patients underwent GK, with the median dose being 28 Gy at 50%. All patients underwent clinical follow‑up and 3 patients had a radiological follow‑up. Six (85.7%) eyes were preserved at follow‑up, and 1 (14.28%) patient developed radiation‑induced cataract. There was a reduction in tumor volume in all patients with radiological follow‑up with the minimum being a 33.06% reduction in size compared to the presenting volume and the maximum being the complete disappearance of tumor at follow‑up. A total of 36 articles presenting various facets of GK usage in UM have been thematically reviewed. Conclusion: GK can be a viable and effective eye‑preserving option for UM with catastrophic side effects becoming rare owing to progressive reduction in radiation dose.