Abstract
<title>Abstract</title> <p>Objective Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. Treatment has shifted from enucleation to eye-preserving approaches, primarily brachytherapy (BT) and proton beam therapy (PT). This study evaluated real-world outcomes of radiotherapy and the impact of demographic, clinical, and treatment factors on survival in patients with localized UM. Methods Data from the North American Association of Central Cancer Registries (NAACCR) covering January 1, 1995, to December 31, 2018, were analysed. Patients with localized UM at presentation were identified. The study employed survival analysis techniques including Kaplan-Meier method, Cox proportional hazards modelling, and logistic regression to examine the association between treatment modalities and survival outcomes. Results The cohort comprised 22,983 patients with localized disease, with 11 740 undergoing BT or PT. The study found comparable 5-year and 10-year overall survival (OS) and cause-specific survival (CSS) rates between the BT and PT groups, with no significant differences observed. Trends in treatment utilization revealed an increase in both groups with limited increase in PT usage beyond 2004. Multivariable analysis identified age and tumour thickness as significant predictors of survival outcomes. There was no significant change of the annual relative survival over the study period. Conclusion The current BT and PT protocols are effective in managing localized UM with similar survival outcomes. The choice of treatment modality should be based on individual tumour characteristics, reinforcing the need for a personalized treatment approach. Further studies are required to refine these treatment strategies to enhance patient outcomes.</p>