Kreusel K.-M., Bechrakis N., Riese J., Foerster M. H.

Universitätsklinikum Benjamin Franklin der Freien Universität, Augenklinik, Hindenburgdamm 30, D-12200 Berlin, Germany

Objective: To compare the effect of "sandwich" therapy (Ru-106 plaque therapy plus transpupillary thermotherapy) with Ru-106 plaque therapy on tumor regression of large malignant choroidal melanoma.
Methods: A consecutive series of 24 choroidal melanomas treated by sandwich therapy was retrospectively compared to 38 melanomas treated by 106-Ruthenium plaque therapy only. Tumors were comparable in tumor prominence (7.0±0.2 vs. 6.9±0.1 mm, p=0.56, range 5.8 to 8.8 mm) and base diameter. Tumor regression was measured by standardized B-scan sonography. Scleral contact doses applied for sandwich therapy vs plaque therapy were 842±41 Gy vs.1126±32 Gy (p<0.0001), respective apex doses were 62±3 vs.105±2.6 Gy (p<0.0001). TTT was performed with a commercial 810 nm Laser (Iris medical, USA) one day before and three months after plaque removal.
Results: Remaining tumor prominence (in % of prominence before therapy) comparing sandwich therapy to plaque therapy was: 72±4% vs. 73±6% (p=0.91) after 6 weeks, 67±4% vs. 72±4% (p=0.39) after 3 months, 55±4% vs. 54±3 (p=0.96) after 6 months and 40±3 vs. 48±3%(p=0.20) after one year. Thus, no difference of tumor regression was observed between both groups.
Conclusion: Applying additional TTT allows a considerable reduction of applied radiation dose in Ru-106 plaque therapy without a loss of tumor control. Thus, additional TTT might be useful in both reduction of radiation induced side-effects and treatment of higher tumors not amenable to Ru- 106 plaque therapy alone.

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