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Dose-volume Histogram Aanalysis in Tumor Regression and Side-effects after Single-fraction Gamma Knife Radiosurgery for Uveal Melanomas
1Langmann G., 2Pendl G., 3Stücklschweiger G., 3Guss H., 2Papaefthymiou G., 1Faulborn J.,
1Karl-Franzens-Universität Graz, Augenklinik (Graz)
2Karl-Franzens-Universität Graz, Klinik für Neurochirurgie (Graz)
3Karl-Franzens-Universität Graz, Klinik für Strahlentherapie (Graz)
Purpose: So far no classification in terms of tumor regression or sequelae does exist in radiosurgery for uveal melanomas. In this study we investigated 31 uveal melanomas treated with a single fraction radiosurgery between 1992 and 1995 and tried to set up comparable parameters in terms of tumor destruction and sequelea.
Patients: 30 patients (15 male, 15 female) had been treated with a mean marginal dose of 52,1 Gy ( range 45-80 Gy). Tumor size was classified in small (smaller than 3 mm prominence -1), medium sized (3-8 mm prominence - 15 patients ) and large (larger than 8 mm prominence and 16 mm diameter- 14 patients). 6 melanomas were juxtapapillary, 10 (juxta) maculary, 5 tumors located in the midperiphery of the fundus and 9 were ciliary body melanomas.
Method: Dose volume histogram analysis.
Results: After a mean follow up of 6 years and 9 months (range 62 - 103 months) 8 tumors regressed to a scar (complete tumor regression), in 17 tumors a reduction of the volume (prominence) between 50 and 80 % occured (partial tumor regression), in 3 tumors no change and in another 2 recurrance was obvious. Sequelae were classsified in mild (3), moderate(3), severe(5) and very severe (19- visual acuity light perception or no light perception), in 7 patients metastatic disease developed.
Conclusions: According to dose - volume histogram analysis significant factors for the development of severe and very severe sequelae were the volume of the tumor, the dose and the location at the ciliary body. The irradiated volume proofed to be much more important than a punctual prescription dose ( i.g. in case of radiation optic neuropathy).