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M. M. Nentwich, A. Muacevic, B. Wowra, A. Kampik, U. C. Schaller; Development of a Frameless, Image-guided Robotic Radiosurgery for the Therapy of Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5777.
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© ARVO (1962-2015); The Authors (2016-present)
Evaluation of the effectiveness and safety of a novel, framelss, image-guided, robotic radiosurgery, which allows treating uveal melanoma within three hours in a single session under retrobulbar anaesthesia.
Thirty- nine (27 male, 12 female) with medium (prominence 3.1-8mm) and lage-sized (prominence > 8mm) unilateral uveal melanomas were treated with a frameless radiosurgery system. Median age was 67 years (range 30-94 years). All patients were treated in a single session consisting of retrobulbar anaesthesia, CT-scanning for the generation of a treatment plan and devlivery of a radiosurgical tumor dose between 18 and 23 Gy to the 70% isodose-line. Three dimensional planning aimed at sparing the lens and optic disc as much as possible. All patients are followed-up at regular intervals (3, 6 ,12 and 18 months after radiosurgery) consisting of clinical examination, ultrasound and CT-scanning.
All patients could be treated in a frameless setup using retrobulbar anestheasia within three hours. In patients with lateral and dorsal uveal melanomas the dose to the lens could be kept below 2 Gy. The clinical response was evaluated for the first 20 patients (12 male, 8 female) where the follow-up was at least 6 months. During the follow-up (range 6-25 months, Median 10 months) local tumor control of the irradiated lesion was achieved in 18/20 patients. One patient with a very large tumor (thickness 9.8mm, base: 11.6x16.5) and one patient with a parapapillar tumor location had to be enucleated during the follow-up period due to tumor growth. Using standardized ultrasound the median maximum apical tumor height regressed from 7.0mm (Quartiles: 4.5mm; 9.8mm) to 4.0mm (3.4mm; 8.4mm) (p<0.05). Median reflectivity increased from 58% (41%;61%) to 70% (60%;75%) during follow-up (p<0.01). No patient suffered from treatment-related complications such as neovascular glaucoma necessitating the enucleation of the eye.
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