PURPOSE: Large uveal melanomas located close to the optic nerve and/ or to the fovea have an unfavourable prognosis with regard to visual preservation and eye retention, due to the high incidence of radiation and tumour necrosis induced complications. Endoresection of the tumour after proton beam irradiation, is an alternative approach, aiming to reduce the incidence of ocular morbidity caused by tumour necrosis after sole radiotherapy. PATIENTS AND METHODS: 32 patients with large uveal melanomas (mean tumour thickness: 9.1 mm, mean tumour volume: 0.77 cc), received a primary proton beam irradiation (60 CGE) and underwent subsequent endoresection via a 3-port pars plana vitrectomy. The median pretreatment visual acuity was 0.2. The mean follow-up was 13.9 months. RESULTS: The postoperative visual acuity after 12 months was 0.12 (median, mean visual acuity loss 0.08). The probability of developing radiation retinopathy or papillopathy within the first year after treatment was 35% and 28% respectively and the probability of enucleation was 9% within the first postoperative year. No tumour recurrences were observed and 2 patients developed liver metastases. CONCLUSIONS: Endoresection following irradiation of large uveal melanomas located close to the optic nerve and/ or the fovea seems to be a useful and safe alternative to the traditional irradiation or enucleation. The incidence of complications following our approach seems to be lower when compared to radiation alone, where tumour necrosis is a substantial problem.
PURPOSE: Large uveal melanomas located close to the optic nerve and/ or to the fovea have an unfavourable prognosis with regard to visual preservation and eye retention, due to the high incidence of radiation and tumour necrosis induced complications. Endoresection of the tumour after proton beam irradiation, is an alternative approach, aiming to reduce the incidence of ocular morbidity caused by tumour necrosis after sole radiotherapy. PATIENTS AND METHODS: 32 patients with large uveal melanomas (mean tumour thickness: 9.1 mm, mean tumour volume: 0.77 cc), received a primary proton beam irradiation (60 CGE) and underwent subsequent endoresection via a 3-port pars plana vitrectomy. The median pretreatment visual acuity was 0.2. The mean follow-up was 13.9 months. RESULTS: The postoperative visual acuity after 12 months was 0.12 (median, mean visual acuity loss 0.08). The probability of developing radiation retinopathy or papillopathy within the first year after treatment was 35% and 28% respectively and the probability of enucleation was 9% within the first postoperative year. No tumour recurrences were observed and 2 patients developed liver metastases. CONCLUSIONS: Endoresection following irradiation of large uveal melanomas located close to the optic nerve and/ or the fovea seems to be a useful and safe alternative to the traditional irradiation or enucleation. The incidence of complications following our approach seems to be lower when compared to radiation alone, where tumour necrosis is a substantial problem.
Authors: Lee M Jampol; Claudia S Moy; Timothy G Murray; Sandra M Reynolds; Daniel M Albert; Andrew P Schachat; Kenneth R Diddie; Robert E Engstrom; Paul T Finger; Kenneth R Hovland; Leonard Joffe; Karl R Olsen; Craig G Wells Journal: Ophthalmology Date: 2002-12 Impact factor: 12.079
Authors: K M Egan; E S Gragoudas; J M Seddon; R J Glynn; J E Munzenreider; M Goitein; L Verhey; M Urie; A Koehler Journal: Ophthalmology Date: 1989-09 Impact factor: 12.079
Authors: E Egger; A Schalenbourg; L Zografos; L Bercher; T Boehringer; L Chamot; G Goitein Journal: Int J Radiat Oncol Biol Phys Date: 2001-09-01 Impact factor: 7.038
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Authors: Johannes Gollrad; Christopher Rabsahl; Antonia M Joussen; Andrea Stroux; Volker Budach; Dirk Böhmer; Alexander Böker Journal: Ocul Oncol Pathol Date: 2021-11-08
Authors: Maja Guberina; Ekaterina Sokolenko; Nika Guberina; Sami Dalbah; Christoph Pöttgen; Wolfgang Lübcke; Frank Indenkämpen; Manfred Lachmuth; Dirk Flühs; Ying Chen; Christian Hoffmann; Cornelius Deuschl; Leyla Jabbarli; Miltiadis Fiorentzis; Andreas Foerster; Philipp Rating; Melanie Ebenau; Tobias Grunewald; Nikolaos Bechrakis; Martin Stuschke Journal: Cancers (Basel) Date: 2022-09-28 Impact factor: 6.575