title: Retrospective evaluation of patients with uveal melanoma treated by stereotactic radiosurgery with and without tumor resection.
abstract: OBJECTIVE
  The present study intended to analyze the suitability of single-dose stereotactic radiotherapy in the treatment of uveal melanoma that cannot be handled with ruthenium-brachytherapy and therefore is a challenge for ophthalmologists concerning local tumor control, as well as preservation of the eye and visual function.
  
  
  OBJECTIVE
  To evaluate local tumor control, eye preservation, visual course, radiation complications, metastases, and death after single-dose stereotactic radiotherapy (SDRT) applied exclusively or combined with tumor resection in uveal melanomas that are neither suitable nor favorably located for ruthenium brachytherapy.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Primary care center.
  
  
  METHODS
  Seventy-eight patients with uveal melanoma were treated.
  
  
  METHODS
  Between June 3, 2003, and March 18, 2008, patients with uveal melanoma received SDRT monotherapy (group 1, 60 patients) or SDRT combined with tumor resection (group 2, 18 patients). Radiotherapy was performed with a tumor-surrounding dose of 25 Gy on a linear accelerator.
  
  
  METHODS
  Local tumor control, eye preservation, visual results, and radiation complications.
  
  
  RESULTS
  Within a median follow-up of 33.7 months (range, 0.13-81.13 months), 6 recurrences occurred in group 1; none recurred in group 2. The Kaplan-Meier estimate for local control was 85% at 3 years in group 1 and 100% in group 2 (P = .22). Eye preservation rate was 77% vs 87% at 3 years (groups 1 and 2, respectively) (P = .82). Visual acuity decreased with a median loss of -18 Snellen lines (group 1) and -22 Snellen lines (group 2). More retinopathies (P = .07), opticopathies (P = .27), and rubeotic glaucomas (P = .10) occurred in group 1. No significant difference was observed in the development of metastases (P = .33). The groups differed in overall survival because of 2 deaths occurring shortly after surgery in group 2 for unexplained reasons (P = .06).
  
  
  CONCLUSIONS
  Survival analysis suggested that SDRT with combined tumor resection might be associated with increased tumor control and fewer radiation complications than SDRT as monotherapy. Both groups had similar eye retention rates and were comparable concerning the decrease in visual function in most eyes. However, the protocol was stopped after 3 unexplainable deaths after surgery.
authors.affiliation: Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany. daniela.suesskind@med.uni-tuebingen.de
authors.forename: Daniela
authors.initials: D
authors.lastname: Suesskind
authors.forename: Jutta
authors.initials: J
authors.lastname: Scheiderbauer
authors.forename: Markus
authors.initials: M
authors.lastname: Buchgeister
authors.forename: Michael
authors.initials: M
authors.lastname: Partsch
authors.forename: Wilfried
authors.initials: W
authors.lastname: Budach
authors.forename: Karl U
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.forename: Rainer
authors.initials: R
authors.lastname: Ritz
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grisanti
authors.forename: Frank
authors.initials: F
authors.lastname: Paulsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D018918:Phacoemulsification; D011183:Postoperative Complications; D016634:Radiosurgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult