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Impressum
Radiosurgical treatment of uveal melanomas using the Gamma-Knife: 3- years-results
1Mueller A. J., 1Schaller U., 1Talies S., 2Horstmann G. A., 2Wowra B., 1Kampik A.
1Augenklinik der Universität, 2Gamma-Knife Center, München, Germany
We report about our experience with stereotactic radiosurgery using the
Gamma-Knife for large and unsuitably located uveal melanomas during the
last five years.
Patients and Methods: 98 patients (50 male, 48 female; 24 - 84
years) were treated since 1997 following a standardized treatment protocol
(outpatient single-treatment, maximum dose 50 Gy, tumor margin dose min.
25 Gy, retrobulbar anesthesia alone for globe fixation). Localization
and/or dimension of tumors did not allow for radiation brachyherapy with
Ru-106 plaques. 16 tumors were located in the ciliary body, 61 tumors
were located at the posterior pole, and 21 tumors were located in the
mid-periphery. All patients were followed ophthalmologically and neuroradiologically
in regular intervals. 1-year follow-up data were available for 73 patients,
2-year follow-up data for 33 patients and 3-year follow-up-data for 15
patients.
Results: Before therapy the maximum apical tumor height (MAH) was
median 7.8 mm (95 % CI 2.9 to 12.5 mm). One year after treatment (73 patients)
the MAH was median 5.7 mm (95 % KI 2.4 to 10.7 mm), 2 years after treatment
(33 patients) the MAH was median 4.3 mm (95 % KI 2.2 to 8.8 mm), and 3
years after treatment (15 Patienten) the MAH was median 4.6 mm (95 % KI
2.4 to 8.5 mm). All differences to the MAH of the corresponding patients
before treatment were statistically significant (paired t-test). Within
the first year after treatment 7 patients were enucleated due to a painful
secondary glaucoma and 2 patients due to a tumor recurrence. Within each
the second and third year one more patient was enucleated (secondary glaucoma).
Conclusions: Our results demonstrate that radiosurgery using the
Gamma-Knife is beneficial in achieving a local tumor control in 98 % of
these eyes with large and unsuitably located uveal melanomas. The risc
for a secondary enucleation is highest in the first year after treatment
with a favorable overallrate of 11 %. Due to the excellent local tumor
control rate we decreased the maximum dose to 40 Gy (min. tumor margin
dose 20 Gy) in the subsequently treated patients.