RESUMEN
BACKGROUND: To report eye salvaging rate, visual acuity (VA), local recurrences, complications and the potential benefit of adjuvant brachytherapy after endoresection of large uveal melanomas. METHODS: 200 patients were included in this retrospective study. They were treated from March 1999 to December 2010 with preoperative stereotactic gamma knife radiosurgery followed by endoresection and adjuvant brachytherapy in most cases. RESULTS: A total of 200 patients were included in this study (113 male, 87 female). Mean tumour height was 9.4â mm and the largest basal diameter ranged from 6.3 to 20â mm. The median follow-up time was 32.3â months. In 13.4% the eye was retained with a VA of 20/50 or better, in 33.6% VA was ranging from 20/400 to 20/50 and 53% had a VA of less than 20/400. In almost 90% of the cases the eye was preserved at the final visit. In 15.5% additional major surgery was required. In terms of survival 15.5% of our patients developed liver metastases during follow-up and died. Local tumour recurrence was observed in 10 out of 200 patients (5%) and was mainly treated with enucleation. The use of an adjuvant ruthenium-106 plaque did not lower the recurrence or enucleation rate significantly. CONCLUSIONS: Eyes with a large uveal melanoma can be preserved by stereotactic radiotherapy followed by endoresection with the chance to obtain useful vision in approximately half of the cases. Adjuvant brachytherapy has no beneficial effect except a reduction of the frequency for major revision surgery.
Asunto(s)
Melanoma/cirugía , Procedimientos Quirúrgicos Oftalmológicos/métodos , Neoplasias de la Úvea/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Braquiterapia/métodos , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Melanoma/radioterapia , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Complicaciones Posoperatorias , Radioterapia Adyuvante , Estudios Retrospectivos , Terapia Recuperativa/métodos , Neoplasias de la Úvea/radioterapia , Agudeza VisualRESUMEN
AIM: To review all cases of suspected vitreous seeding of treated or untreated uveal melanoma at our clinic and to compare clinical, cytological and histological findings with patients' survival. METHODS: Retrospective non-randomised study of 23 patients with consecutive uveal melanoma who underwent diagnostic vitrectomy in our clinic between January 2000 and November 2013. Reason for vitrectomy was suspected dissemination of tumour cells inside the eye. Treated as well as treatment-naïve primary uveal melanomas were included in this study. Follow-up data of all patients were collected. RESULTS: The study included 23 patients with a mean age of 66â years. Four patients presented pigmented vitreous debris at initial presentation prior to treatment of the uveal melanoma. All but one of these four patients has been enucleated as a consequence of cytology-proven vitreous spreading of vital melanoma cells. The remaining 19 patients presented pigmented vitreous debris at a mean of 60â months following local tumour treatment. Thirteen of these patients had been treated with a ruthenium plaque (mean scleral dose 1295â Gy, mean apex dose 152â Gy), three with binuclid plaque (mean scleral dose 1005â Gy, mean apex dose 70â Gy) and three with proton beam radiation. Of the 19 patients, 10 showed only melanophages in the vitreous specimen, while the remaining 9 patients had vital tumour cells in vitreous cytology. Four out of these nine patients have been enucleated in the course of follow-up. During follow-up of our cohort of 23 patients, 4 patients died, but only 1 of them due to metastatic disease. CONCLUSION: The outcome of this small cohort study shows that obtaining a vitreous specimen helps to distinguish melanophages from vital tumour cells. We could not observe an increased risk of metastasis in patients who showed melanoma cell dissemination inside the eye, compared with those patients only showing melanophages. We therefore suggest to carefully re-evaluate the necessity of enucleation in every patient.