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Endoresection following Proton Beam Irradiation of Large Uveal Melanomas
1Bechrakis N. E., 1Kreusel K.-M., 2Nausner M., 3Martus P., 4Heese J., 4Kluge H., 1Foerster M. H.,
1Freie Universität Berlin, Klinikum Benjamin Franklin, Augenklinik (Berlin)
2Freie Universität Berlin, Klinikum Benjamin Franklin, Strahlenklinik (Berlin)
3Freie Universität Berlin, Klinikum Benjamin Franklin, Institut für Medizinische Informatik, Biometrie und Epidemiologie (Berlin)
4Hahn-Meitner Institut (Berlin)
Purpose: Large uveal melanomas located close to the optic nerve and/or fovea have an unfavorable prognosis with regard to visual preservation and eye retention, due to the high incidence of radiation induced complications. Endoresection of the tumor is an alternative approach, which might prove to be useful in these challenging cases.
Patients and Methods: 20 patients with large uveal melanomas (tumor prominence: 6,3-14,0 mm, mean: 9,0 mm) located 0,5 to 5 mm from the optic disc and/or the fovea, received a primary proton beam irradiation (60 CGE) and underwent subsequent endoresection via a 3-port pars plana vitrectomy, with SF6 or silicone oil tamponade. The pretreatment visual acuity varied between 20/600 in one patient and 20/200 to 20/20 (mean: 20/40) in all other patients. The mean follow-up was 12 months.
Results: Two patients of this series (pretreatment VA: 20/600 and 20/200) required enucleation due to retinal detachment and persistent hypotony. In all other patients (n: 18) eye retention was achieved. One patient required a second vitreoretinal procedure due to a peripheral retinal detachment. The mean loss of VA was 2,9 lines to a mean value of 20/100 after 12 months. No tumor recurrences were observed.
Conclusions: Endoresection following irradiation of large uveal melanomas located close to the optic nerve and/or the fovea seems to be a useful and safe alternative to the traditional irradiation or enucleation. The incidence of complications following our approach seems to be lower when compared to radiation alone, where tumor necrosis is a substantial problem. However, preoperative irradiation seems to be mandatory in order to minimize the risk of tumor recurrence.