NEW DEVELOPMENTS IN THE TREATMENT OF INTRAOCULAR TUMORS: PROTON TREATMENT, TRANSSCLERAL LOCAL RESECTION

97th DOG Annual Meeting 1999

R610
NEW DEVELOPMENTS IN THE TREATMENT OF INTRAOCULAR TUMORS: PROTON TREATMENT, TRANSSCLERAL LOCAL RESECTION

M. H. Foerster, N. Bornfeld, N. Bechrakis, U. Kellner, I. Zöller

Proton treatment and local resection are relatively new options in the treatment of intraocular tumors including uveal melanoma and other tumors like cavernous hemangioma of the choroid. Advantages of proton radiation are a steep lateral dose fall off (penumbra) and a sharp dose fall off at the end of the target volume(Bragg-peak). Disadvantages are the lack of an isocentric radiation and the need for a 62 MeV cyclotron. The analysis of the experience of the first years of proton treatment allowed refinement of solid indications for proton treatment of uveal melanoma. These indications include tumors of the posterior pole not touching the optic disc and in particular iris melanomas. The integration of up to date imaging techniques including high resolution magnet resonance imaging of the orbit will further improve the precision and effectiveness of proto

Large intraocular melanomas are still a therapeutic challenge. Local and external beam readiotherapy may result in sufficient local tumor control keeping a functional eye. In the majority of cases with large intraocular melanomas, however, radiation related complications including therapy resistant secondary glaucoma will result at least in functional less of the tumor containing eye. Transscleral local resection has improved the progonsis of these eyes considerably resulting in better local tumor control and better funtional results. In comparison to y-brachytherapy local resection has besser functional results with particular reference to the long term follow-up.

Disadvantages of the procedure are increased immediate surgical risks and the effort needed to perform the procedure in arterial hypotension and hypothermia.

Berlin
Essen

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