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Irina Panova, Elena Guntner, Irina Kuchenkova; Organ Preservation Treatment for Choroidal Melanoma (CM). Invest. Ophthalmol. Vis. Sci. 2012;53(14):3401.
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Priority direction in the medicine of CM is organ-preservation treatment including brachytherapy (BT), transpupillary thermotherapy (TTT) and their combination. Use of photodynamic therapy (PDT) is still controversial. Our goal was to develop an improved strategy for patients with CM, based on differential approach taking into account clinical course of the disease.
This retrospective study included data analysis of ultrasound (GE Logiq 9, National Unltrasound, Duluth, GA) monitoring of the eyes of 125 patients with CM; Mean±St.Err. age of the patients was 55.8±11.5 years; 40% were males, 60% were females. 20% had CM 1 stage, 77.6% - 2 stage and 2.4% - 3 stage. TTT was performed on Diode Ophthalmic Laser Coagulator "Alod-Alcom" (Alcom Medica, Saint-Petersburg, Russia). PDT (photoditazin) was performed on PDT Laser "Alod-01" (Alcom Medica, Saint-Petersburg, Russia). BT was performed using ophthalmoapplicator Ru/Rh 106 (Institute of Physics and Energetics, State Scientific Center of Russian Federation, Obninsk, Russia).
When elevation of CM was ≤3.5mm and the tumor had equatorial-to-peripheral localization, the most effective treatment was TTT. For CM of central localization, with diffusive form of growth, and elevation of 3.6-4.7mm, the following two-step TTT provided the best results: first TTT was performed over the periphery of the tumor and then, in 3-4 months, second TTT was performed over the center of the tumor (full regression was observed in 87.5%). When the elevation of the CM was ≥4.7mm, combined TTT followed by BT showed the best outcomes (full regression was observed in 70.97%). PDT provided the best outcomes in pigment-free, well-vascularized CM (full regression was observed in 77.3%).
Our results may help improving the indication criteria to determine treatment strategy for patients with CM, based on the clinical features of CM.
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