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M. Marinkovic, B. Jurklies, G. Horstmann, H. Akgül, D. Flühs, W. Sauerwein, N. Bornfeld; Transretinal Endoresection After Ancillary Single Shot Stereotactic Radiotherapy vs Brachytherapy With a Bi-Nucleotide Applicator in the Management of Large Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5258.
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To study the treatment related morbidity, eye retention rate, preservation of visual function and treatment related complications in a consecutive series of large uveal melanomas (n=284) treated either with transretinal endoresection following ancillary stereotactic radiation or brachytherapy with 106-ruthenium/125-iodine bi-nuclide radioactive eye plaque.
The endoresection technique consisted of pre-surgical single shot radiation of the tumor with a Leksell Gamma Knife with target volume dose of 25 Gray and immediate subsequent transretinal endoresection via a pars plana approach with silicone tamponade (n=103) and supplementary local beta ray radiation of the tumor base in selected cases (47/103). Brachytherapy was performed using a bi-nuclide plaque (Med Phys 2004 31:1481) delivering 70 Gray at the tumor apex (n=181).
Mean follow up in the whole series was 24,3 months. Mean initial tumor thickness was 8,9 mm in both groups (8,6 mm in the brachytherapy group and 9,3 mm in the endoresection group). Eye retention rate in the endoresection group was 90,3% compared to 85,1% in the brachytherapy group. Functional blindness defined as reduction of visual function to counting fingers or less occurred in 15,4% of the endoresection group and in 22,4 of the brachytherapy group. These differences were present but not statistically different in univariate analysis using Kaplan-Meier statistics. Recurrent tumor growth occured in 4 eyes of the endoresection group but in 13 eyes of the brachytherapy group. This difference was statistically significant in univariate Kaplan-Meier analysis (p<.05). No extraocular tumor growth occured in both groups; in particular no tumor cell seeding occurred in the endoresection group.
Bi-nuclid brachytherapy and transretinal endoresection following stereotactic radiotherapy may salvage an eye with a large uveal melanoma preserving usefull function. If feasible transretinal endoresection should be preferred as functional results and local tumor control are more favorable compared to brachytherapy.
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