Endoresection of Large Uveal Melanomas After Tumor-Destroying Stereotactic Radiosurgery

Abstract

Abstract: : Purpose: Conventional radiotherapy of uveal melanomas with large volume and height is characterized by a high incidence of secondary complications that may necessitate a later enucleation. These complications compromise radiation-induced side effects and more often massive inflammatory reactions with total exsudative retinal detachment and severe secondary glaucoma. Endoresection after a tumor-destroying stereotactic irradiation may be an alternative approach for an eye salvaging therapy in those cases. Methods: Between March 2000 and October 2001 25 eyes with large uveal melanomas underwent stereotactic radiosurgery (Leksell Gamma-knife) before endoresection of the tumor via a standard 3-port-vitrectomy including lasercoagulation and tamponade with silicone oil. The average thickness of the tumors was 10.2 mm. The mean dose delivered to the tumor volume was 43 Gy (SDEV 7 Gy). The D90 (dose delivered to at least 90% of the target volume) was 36 Gy in average (SDEV 8.9 Gy). Results: The average follow-up time is 307 days. 4 eyes (16%) had to be enucleated after radiosurgery due to complications such as total exsudative retinal detachment combined with secondary glaucoma (2 cases) and to massive choroidal and vitreous hemorrhage (2 cases). In 21 cases (84%) the eyes could be retained with a median visual acuity of 0.2. In three cases a lavage of the anterior chamber was necessary because of shifting hemorrhage from the resection site. Proliferative vitreoretinopathy was not observed. Conclusions: Devitalisation of the tumor by stereotactic radiosurgery using the Leksell gamma-knife seems to be a promising technique to avoid local tumor seeding after endoresection of large uveal melanomas and to preserve a functional visual acuity in eyes that otherwise would have been enucleated. None

Keywords: 464 melanoma • 628 vitreoretinal surgery • 538 radiation therapy