Abstract

SO.07.02

Long-term results after endoresection with pre-treatment by single-dose stereotactic convergence irradiation and adjuvant brachytherapy in large uveal melanomas

Eva Biewald1, Michael Freistühler1, Mete Gök1, Gerhard A. Horstmann2, Norbert Bornfeld1
1Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen, 2Gamma Knife Zentrum Krefeld, Krefeld

Background
The aim of this retrospective, non-comparative, consecutive case study is to evaluate the long-term results after single-dose stereotactic convergence irradiation, endoresection and brachytherapy in large uveal melanomas, particularly regarding functional outcome, secondary complications, additional surgery and tumour control.
Methods
This retrospective case study included 113 patients treated in the period from March 1999 to July 2008. All patients underwent single-dose stereotactic radiosurgery followed by endoresection and adjuvant brachytherapy with ruthenium106. The average tumour height was 9.5mm and the median follow up 23.8 months.
Results
The median postoperative visual acuity was 0.05 with 19 patients (16.8%) retaining a visual acuity of 0.3 or better. Complications included serious haemorrhages in 12 patients (11.7%) directly following surgery, a retinal detachment in 17 patients (15%), a secondary glaucoma in 11 (9.7%) patients and in 14 patients (12.4%) a radiogenic retinopathy. One Patient experienced a serious scleromalacia. Additional major surgery was required in 26 patients (23%). In total 15 eyes (13.3%) were enucleated due to serious complications or insufficient tumour control. Tumour recurrences were observed in six cases leading to an additional treatment with ruthenium in 2 patients (1.77%) or a transpupillary thermo-therapy in the remaining four (3.54%).
Conclusions
For large uveal melanomas, endoresection and brachytherapy following single-dose stereotactic convergence irradiation is often the only eye and vision saving treatment option. A fair residual visual acuity was maintained in several patients.

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