[Transpupillary thermotherapy in the treatment of choroid melanoma].
OBJECTIVE
To report the results of primary transpupillary thermotherapy (TTT) for selected posterior pole choroidal melanomas.


METHODS
Prospective non randomized study including 34 patients with choroidal melanoma treated with TTT using near-infrared radiation (810 nm) delivered from the diode laser. All treated tumors had either documented growth or clinical risk factors for future growth and/or metastasis. The treatment was delivered using a specially modified infrared diode laser through a slit lamp adaptor. A contact lens was placed on the cornea to view the fundus and focus the laser beam. Treatment was initiated using a 60-second exposure and a low energy level at 300 mW with a 3.0 mm beam width. The energy was raised stepwise by 50 to 100 mW until the surface of the tumor develop a light grayish discoloration. The TTT sessions were delivered at 3-month intervals.


RESULTS
Among these 34 patients with choroidal melanoma, 29 patients presented with primary choroidal melanoma. Five tumors (15%) were late recurrences after conservative treatment. The mean initial tumor basal diameter was 7.2 mm and tumor thickness was 2.9 mm. Seventeen tumors (50%) touched the optic disc and 10 (29%) were under the fovea. After a mean of three treatment sessions and 20 months of follow-up, the mean tumor thickness gradually decreased to 2.3 mm at month 3 and 2.0 mm at month 6 after the initial TTT. The percent reduction of tumor thickness was 20% at month 3 and 29% at month 6. The mean final thickness was 1.7 mm. Treatment was successful in 33 patients (97%). Tumor regrowth was documented in one patient (3%) and required plaque radiotherapy. After treatment, visual acuity was the same or better than the pretreatment visual acuity in 21 eyes (62%) and worse in 13 eyes (38%). Intraocular complications included retinal traction in 12 eyes (34%) and vascular occlusion in 3 eyes (9%).


CONCLUSIONS
This series confirms the efficacy of transpupillary thermotherapy in the management of selected posterior pole choroidal melanomas. Longer follow-up is still required to assess late local recurrence and the impact on metastatic disease.
De Potter
P
P
Unité d'Oncologie Oculaire, Service d'Ophtalmologie, Cliniques Universitaires St-Luc Avenue Hippocrate, 10, 1200 Bruxelles. depotter@ofta.ucl.ac.be
Levecq
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002830:Choroid Neoplasms / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000379:methods; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D011680:Pupil