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AJ Mueller, UC Schaller, M Thiel, S Talies, G Horstmann, B Wowra, A Kampik; Local Tumor Control Rate and Risk of Secondary Enucleation in Low-dose Radiosurgical Treatment of Uveal Melanomas . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1149.
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Purpose: To report the local tumor control rate and risc of secondary enucleation in low-dose radiosurgical treatment of large and unsuitably located uveal melanomas using the Gamma-knife*. Methods: 100 patients (51 male, 49 female; 24 - 84 years) were treated since 1997 following a standardized treatment protocol (outpatient single-treatment, maximum dose 50 Gy, tumor margin dose min. 25 Gy, retrobulbar anesthesia alone for globe fixation). Localization and/or dimension of tumors did not allow for radiation brachyherapy with Ru-106 plaques. 16 tumors were located in the ciliary body, 61 tumors were located at the posterior pole, and 21 tumors were located in the mid-periphery. All patients were followed ophthalmologically and neuroradiologically in regular intervals. 1-year follow-up data were available for 73 patients, 2-year follow-up data for 33 patients and 3-year follow-up-data for 15 patients. Results: Within the first year after treatment 7 patients (12 %) were enucleated due to a painful secondary glaucoma and 2 patients (3 %) due to a tumor recurrence. Within each the second and third year one more patient (3 % and 6 % resp.) was enucleated, both due to a secondary glaucoma. Conclusion: A local tumor control was achieved in 98 % of the treated patients. The risc for a secondary enucleation is highest in the first year after treatment with a favorable overall-rate of 11 %. Due to the excellent local tumor control rate we decreased the maximum tumor dose to 40 Gy (min. tumor margin dose 20 Gy) in the subsequently treated patients which should further reduce the radiation induced side-effects as secondary glaucoma. *Mueller et al.: Stereotactic radiosurgery of large uveal melanomas with the Gamma-knife. Ophthalmology 107 (2000) 1381-1387
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