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P. I. Foerster, U. C. Schaller, B. Wowra, A. J. Mueller, A. Kampik; Long-Term Results After Treatment With Gamma-Knife in Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5230.
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Uveal melanoma with a maximal apical tumor height over 6 mm or a maximal basal diameter over 19 mm are not suitable for treatment with Ru-106 brachytherapy. In addition to enucleation since 1997 treatment with gamma-knife is accessible in Munich for those patients.Aim of this study is to describe the 1-, 3- 5- year follow up results according to local tumor control, radiation side effects such as secondary glaucoma leading to secondary enucleation and visual results.
In total 146 patients where examined after having been treated with gamma-knife.
The mean age at date of diagnosis was 60,5 years. Median of maximal apical tumor height was 8 mm with a KI of 95 % 4,1 - 11,2 mm. 30 patient fulfilled a 5 year follow-up, 67 a three year follow-up and 126 Patient a 1 year follow-up. Median follow-up was 28 month. 11 Eyes had to be enucleated due to local recurrence. In 17 patients radiation side effects led to secondary enucleation. In most patients visual acuity decreased significantly within 12 month after treatment, after 36 month visual acuity of 20/200 or more was achieved only in rare cases.
In conclusion gamma-knife radiation is a suitable alternative to primary enucleation in large uveal melanoma, with local tumor control rate over 90%, but patients have to be aware of failure of eye retention due to side effects in about 12% and significant loss of vision.
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