Abstract
Purpose: :
To review charts of patients diagnosed with suspected small posterior pole choroidal melanoma over the last ten years who were treated with primary transpupillary thermotherapy (TTT); and to evaluate the therapeutic indications and the efficacy of such treatment in a private practice setting.
Methods: :
Charts from Illinois Retina Associates were reviewed for patients who were diagnosed with suspected choroidal melanoma and treated with primary TTT. Data collected included: age, sex, date of diagnosis, tumor size and location, treatment date, visual acuity at diagnosis, re-treatment (if applicable), date of recurrence (if applicable), and follow-up duration.
Results: :
Twenty-six patient charts were reviewed dating from 5/1997 to 10/2006, each had received TTT as primary therapy for suspected posterior pole melanoma. All patients had been examined and treated by the same physician,and all TTT treatments were delivered with diode laser using powers of 400-1400mW with duration of 1 minute and spot size of 3.0mm. Success was measured as tumor regression without recurrence and was noted in 16 of 26 patients (61.54%). Ten of the 26 patients (38.46%) failed TTT as primary therapy and required further intervention. None of these patients were noted to have metastasis at the time of failure.
Conclusions: :
In comparison to larger studies performed in academic institutions, treatment failure is higher in this private practice setting. Further evaluation of the failure group was performed to determine what factors may contribute to the increased rate of failure. Tumor location adjacent to the macula or optic nerve, and inferotemporally was more successful with primary TTT than tumors in other locations; however, this finding was not statistically significant. Tumor area and volume measurements were evaluated in the success and fail categories, but also showed no statistical significance in determination of outcome. The use of primary TTT for small posterior pole melanomas is a good alternative to primary brachytherapy or enucleation, but the overall outcomes in this private practice setting have a higher fail rate than quoted in larger studies in the academic setting.
Keywords: melanoma • uvea • tumors