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M. M. Nentwich, A. Muacevic, A. Klingenstein, B. Wowra, A. Kampik, U. C. Schaller; Cyberknife Radiosurgery in the Therapy of Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5139.
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Evaluation of the effectiveness and safety of framelss Cyberknife radiosurgery, which allows treating uveal melanoma within three hours in a single session under retrobulbar anaesthesia.
Sixty-five (39 male, 26 female) with medium (prominence 3.1-8mm) and lage-sized (prominence > 8mm) unilateral uveal melanomas were treated with a frameless radiosurgery system. Median age was 67 years (range 28-94 years). All patients were treated in a single session consisting of retrobulbar anaesthesia, CT-scanning for the generation of a treatment plan and devlivery of a radiosurgical tumor dose between 18 and 23 Gy to the 70% isodose-line. Three dimensional planning aimed at sparing the lens and optic disc as much as possible. All patients are followed-up at regular intervals (3, 6 ,12 and 18 months after radiosurgery) consisting of clinical examination, ultrasound and CT-scanning.
All patients could be treated in a frameless setup using retrobulbar anestheasia within three hours. In patients with lateral and dorsal uveal melanomas the dose to the lens could be kept below 2 Gy. The clinical response was evaluated for the first 39 patients (26 male, 13 female) where the follow-up was at least 6 months. During the follow-up (range 6-37 months, Median 14 months) local tumor control of the irradiated lesion was achieved in 37/39 patients. One patient with a very large tumor (thickness 9.8mm, base: 11.6x16.5) and one patient with a parapapillar tumor location had to be enucleated during the follow-up period due to tumor growth. Using standardized ultrasound the median maximum apical tumor height regressed from 6 mm (Quartiles: 4.2 mm; 7,9 mm) to 4 mm (3.3 mm; 7.1 mm) (p<0.01). Median reflectivity increased from 52% (45%; 61%) to 64% (57%; 71%) during follow-up (p<0.01). No patient suffered from treatment-related complications such as neovascular glaucoma necessitating the enucleation of the eye.
Cyberknife radiosurgery is an effective and safe therapeutic option with high patient comfort for the treatment of uveal melanoma. A longer follow-up and analysis of a larger patients group is necessary in order for definite assessment.
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