Combined Simultaneous Transpupillary Thermotherapy-ICG Enhanced Photodynamic Therapy (CSTIP) versus CSTIP+Ranibizumab for the Treatment of Choroidal Melanoma

Abstract

Purpose: : To evaluate the safety and efficacy of CSTIP versus CSTIP + Ranibizumab for the treatment of Choroidal Melanoma.

Methods: : Two studies previously completed were compared and analyzed. CSTIP is a retrospective study that evaluated 46 patients and followed them along 12 years. CSTIP + Ranibizumab is a prospective study that recruited 10 patients who were followed along 2 years. All the patients were 18 years old or older with a small or medium size choroidal melanoma. In every visit, each patient underwent a complete ophthalmological evaluation. The tumor activity was evaluated with Fluorescein angiogram and B-scan ultrasonography. Outcome measures were visual acuity and tumor activity.

Results: : Fifty six patients were studied. All patients received transpupillary thermotherapy + ICG enhanced photodynamic therapy. Ten patients received a mean of 6.7 monthly injections of Ranibizumab as adjuvant treatment. In general, a higher incidence in females was found(60-80%). Mean age was 66 year old in CSTIP and 67.5 year old in CSTIP + Ranibizumab. The laterality was variable. It is a very interesting finding that the mean number of CSTIP required to control the tumor locally was 2.15 (2.1-2.2). However, it is important to reassure that the number of recurrences with CSTIP alone were 4.34% while with CSTIP + Ranibizumab were 40%. Complications including subconjunctival hemorrhage, cystoid macular edema, peripheral branch retinal vein occlusion and recurrence were seen in both groups. Their incidence was variable and did not affect the control of the disease.Visual acuity was stabilized in 30% of the CSTIP patients and in 80% of the CSTIP + Ranibizumab group. Some of the patients receiving CSTIP alone were treated previously with Iodine¹²⁵ brachytherapy and this is a factor contributing to a worse visual acuity in these patients.

Conclusions: : CSTIP is a well tolerated and efficient treatment to control small or medium size choroidal melanomas. A mean number of 2.15 treatments are required. It appears to be that consecutive treatments are more effective. Ranibizumab as adjuvant therapy did not prove benefit, however it might help to improve the perfusion of the retina. New studies are needed to determine the role of Ranibizumab in Choroidal melanoma treatment.

Clinical Trial: : www.clinicaltrials.gov NCT00541528

Keywords: melanoma • laser • choroid