Robotic CyberKnife Radiosurgery for the Treatment of Choroidal and Ciliary Body

center dot PURPOSE: To present the results of robotic-assisted radiosurgery in choroidal and ciliary body melanomas treated at the Department of Ophthalmology of Ludwig-Maximilians-University and the European CyberKnife Center in Munich, Germany.center dot DESIGN: Interventional case series center dot METHODS: This retrospective study included 594 con-secutive patients referred to our clinic for the treatment of choroidal and ciliary body melanomas with robotic ra-diosurgery (CyberKnife) from 2005 to 2019. Eye reten-tion, local control and disease-specific survival rates were calculated as Kaplan-Meier and actuarial estimates. The impact of prescription dose, tumor size, and ciliary body involvement was assessed by likelihood ratio tests and Cox regression.center dot RESULTS: Among all patients who were staged ac-cording to the TNM classification system (8th edition), 22.7% were I, 57.9% were II, 18.9% were III, and 0.5% were IV. Median apical tumor height and base diameter were 5.8 and 11.4 mm. The mean follow-up was 41.7 months. Local control after 3 and 5 years was 92.0% (95% CI = 88.2%-94.7%) and 84.3% (95% CI = 77.9%-89.0%), respectively, for 21 to 22 Gy and 86.9% (95% CI = 79.7%-91.7%) and 77.7% (95% CI = 68.5%-84.6%), respectively, when treated with 20 Gy or less. Eye retention was achieved in 89.9% and 81.0% after 3 and 5 years with 21 to 22 Gy and 85.9% and 80.0% for 20 Gy or less. Disease-specific survival rates were 93.1% (95% CI = 90.2%-95.2%) after 3 years, 89.8% (95% CI = 86.0%-92.6%) after 5 years, and 87.8% (95% CI = 82.8%-91.4%) after 7 years.center dot CONCLUSIONS: This is the largest series of patients treated for choroidal and ciliary body melanomas with Cy-berKnife. Our results reflect an improvement in the out-come of CyberKnife therapy for patients with choroidal and ciliary body melanoma treated with single-session radiosurgery in the last decade. (Am J Ophthalmol 2023;250: 177-185. (c) 2022 Published by Elsevier Inc.)