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Erschienen in:
01.01.2013 | Oncology
Gamma-knife-based stereotactic radiosurgery for medium- and large-sized posterior uveal melanoma
Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 1/2013
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Background
This study investigated the use of gamma-knife-based stereotactic radiosurgery (GKRS) for medium- and large-sized posterior uveal melanoma treatment.
Methods
We assessed 50 eyes from 50 consecutive patients with uveal melanoma who were treated with GKRS. All tumors met the criteria for medium- and large-sized uveal melanomas. Patients underwent a single session treatment under local anesthesia; the prescribed radiation dose at the tumor periphery was standardized to 30 Gy at the 50 % isodose field for all patients. The main outcomes were local tumor control, eye retention, and survival rates.
Results
The median follow-up time was 40 months (16–78 months). The baseline mean tumor diameter was 10.3 mm (7.1–15.7 mm) and the apical tumor height was 8.7 mm (4.1–16.8 mm). After treatment, the mean tumor diameter was 8.7 mm (5.5–12.0 mm) and the tumor height was 6.2 mm (0.5–11.2 mm). Changes in both tumor height and diameter were statistically significant (p < 0.001). The tumor control rate was 90 %, and the eye retention rate was 82 %. A total of nine patients (18 %) developed metastasis, and seven (14 %) died due to metastasis during follow-up. Cataracts (34 %) and radiation maculopathy (30 %) were the most frequent complications, and 14 % of patients developed neovascular glaucoma. Visual acuity (VA) decreased significantly after treatment (p < 0.0001).
Conclusion
Treatment using low doses of GKRS, (30 Gy) is an eye-sparing outpatient option for patients with medium- or large-sized posterior uveal melanomas who are not eligible for brachytherapy or particle therapy. Complications, particularly impaired VA, should be taken into consideration.