Endoresection Efficiency Regarding Neovascular Glaucoma Prevention After Proton Beam Therapy In Large Uveal Melanomas

Abstract

Purpose: : Large uveal melanomas have an unfavourable prognosis regarding to eye retention, due to the high incidence of radiation and tumor necrosis induced complications. Endoresection of the tumor after proton beam irradiation is a surgical method aiming to reduce the incidence of ocular morbidity caused by tumour necrosis after radiotherapy.

Methods: : 63 patients with large uveal melanomas ( tumour diameter> 10 mm and thikness> 8 mm) received 60 Gy by proton beam therapy and then, underwent endoresection of the tumoral scar. Mean follow up was 23 months. The rates of neovascular glaucoma (NVG) and secondary enucleation were observed .

Results: : The survival rate without NVG after 2 years was 94,3% (p<0,05%) and the survival rate without secondary enucleation after 2 years was 96,1% (p<0,05%). Comparing with the treatement by proton beam therapy alone and the treatement by proton beam therapy associated with Laser therapy, the RR of developping a NVG was 0,18 ( reduction of 82%) after endoresection.

Conclusions: : Endoresection following irradiation of large uveal melanomas seems to be a useful and safe alternative to the proton beam radiotherapy alone or proton irradiation combined with Laser therapy.The incidence of complications following our approach seems to be lower where tumour necrosis is a substantial problem.

Keywords: tumors • melanoma • uvea