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Eva M. Biewald, Wolfgang Sauerwein, Michael Freistuehler, Mete Goek, Hilke Lautner, Norbert Bornfeld; Longterm Results After Endoresection Of Large Uveal Melanomas With Preoperative Stereotactic Radiation And Adjuvant Brachytherapy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3413.
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The aim of this non-comparative, consecutive case series is to evaluate the long-term results after endoresection of large uveal melanomas in combination with pretreatment with stereotactic gamma knife radiosurgery and adjuvant ruthenium brachytherapy in most cases.
Between May 1999 and December 2011, 230 patients with large uveal melanomas underwent stereotactic radiosurgery followed by endoresection of the tumour via a standard three-port vitrectomy including laser photocoagulation and silicone oil tamponade. 163 patients were treated with adjuvant ruthenium brachytherapy. Patients with a juxtapapillary melanoma or an only eye usually did not receive a plaque. The average tumour height was 9.3 mm, 21% of our patients had a ciliary body involvement. The minimum dose delivered to the tumour volume was 25 Gy.
The median follow-up time was 37 months, with a range from 10 years to 66 days. Mean preperative visual acuity was 0,29 and dropped to 0,04 after surgery. Local tumour recurrences were observed in 12 cases leading to an additional treatment with ruthenium, a transpupillary thermotherapy or an enucleation. Patients who did not receive a preoperative stereotactic tratment had a 25% risk of local recurrence. All in all 9,6% of our patinets were enucleated after 7 months on average due to loss of tumour control, secondary glaucoma, phthitical globe or a persisting haemorrhage. After 36 months 20% of our patients developed liver metastases. An involvement of the ciliary body reulted in a much earlier meastatatic deasease and showed a worse visual acuity postoperative.
Eyes with large uveal melanomas can be salvaged by stereotactic radiotherapy followed by endoresection. The prognosis worsens if the ciliary body is affected. A fair residual visual acuity was maintained in serveral patients.
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