[Endoresection following proton beam irradiation of large uveal melanomas].
OBJECTIVE
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.


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.
Bechrakis
N E
NE
Augenklinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin. nikolaos.bechrakis@medizin.fu-berlin.de
Höcht
S
S
Martus
P
P
Kreusel
K M
KM
Heese
J
J
Foerster
M H
MH
D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007910:Lenses, Intraocular; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology; D011522:Protons; D011832:Radiation Injuries / Q000209:etiology; D011880:Radiotherapy Planning, Computer-Assisted; D012160:Retina / Q000528:radiation effects; D014057:Tomography, X-Ray Computed; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery*; D014792:Visual Acuity / Q000528:radiation effects; D014821:Vitrectomy
D011522:Protons