Cancer Treatment Today

There is little to support surveillance imaging with PET and for mroe than 5 years.
No high-level studies are available to inform the most appropriate monitoring for patients who have undergone treatment for uveal melanoma (I use these guidelnins as relevant to “retinal” melanoma). As such, no consensus has been reached within the ophthalmic or oncologic community about the role of surveillance for detection of metastases in those patients. Because evidence concerning surgical resection has suggested improved survival, there is a trend toward the use of rigorous follow-up in high-risk patients. The median time to develop liver metastases is approximately 2.5 years; management of metastatic disease might therefore achieve more favourable outcomes when the metastasis is detected early.

Clinical characteristics and tumour genetics predict survival. A customized follow-up routine based on the patient’s risk category is therefore recommended. Ultrasonography has demonstrated high specificity (100%), but low sensitivity (14%) for the detection of uveal melanoma liver metastases. The use of us in the follow-up of high-risk patients should therefore complement other, more sensitive, tests. Several studies have looked at the use of various imaging modalities in detecting metastases, particularly in the liver, at follow-up. Magnetic resonance imaging offers consistently good sensitivity (92%–96%); the sensitivity of pet-ct is variable (35%–100%). In a head-to-head comparison of mri and pet-ct, sensitivity was higher with mri (67% vs. 41%, p = 0.01), and positive predictive value was slightly higher with pet-ct (95% vs. 100%, p = 0.01)35. The authors concluded that mri was superior to pet-ct for detecting liver metastases from uveal melanoma. In a cohort of 188 high-risk patients, 6-monthly mri of the abdomen detected metastases before symptoms in 92% of patients, resulting in 14% of patients qualifying for liver resection104. Consensus-based guidelines recommend that follow-up consist of annual history and physical exam, liver function tests, pet-ct or mri of abdomen, plain radiography of chest, and liver us. High-risk patients require more frequent imaging. To date, no data on the impact of follow-up on survival are available adn both Ct and PET are mentioned as useful. Therefore, requiring that PET be reserved to follow CT scan is resonable. Surveillance beyond 5 years is not supported.

E. Weis et al, Management of uveal melanoma: a consensus-based provincial clinical practice guideline. Curr Oncol. 2016 Feb; 23(1): e57–e64.

Francis JH, Patel SP, Gombos DS, Carvajal RD. Surveillance options for patients with uveal melanoma following definitive management. Am Soc Clin Oncol Educ Book. 2013:382–7.