What dose/fractionation would you consider for SBRT of uveal melanomas too large for plaque brachytherapy?

Stereotactic hypofractionated radiation, and/or high dose proton beam therapy are safe alternatives to eye enucleation in COMS large uveal melanoma patients. Aside from the size of the tumor, dosing can vary based on the modality used for treatment. Although most treatments show good control rates, there seems to be a trade-off with different modality/deliverable dose, and eye preservation and toxicity. Thus, establishing the ideal BED based on tumor size and location seems to still be evolving given the limited number of patients and established treatment centers.

For COMS large tumors, proton therapy delivered at 70 Gy (cGe) in 5 fractions has been noted to have good local control rates as well as allowing eyesight preservation if the le...

Protons 60 Gy in 4 fractions.