Acta Neurochirurgica

, Volume 154, Issue 4, pp 605–610 | Cite as

Survival and complications following Gamma Knife radiosurgery or enucleation for ocular melanoma: a 20-year experience

  • Eduard B. Dinca
  • John Yianni
  • Jeremy Rowe
  • Matthias W. R. Radatz
  • Daniel Preotiuc-Pietro
  • Paul Rundle
  • Ian Rennie
  • Andras A. KemenyEmail author
Clinical Article



We present our experience in treating ocular melanoma at the National Centre for Stereotactic Radiosurgery in Sheffield, UK over the last 20 years.


We analysed 170 patients treated with Gamma Knife radiosurgery, recorded the evolution of visual acuity and complication rates, and compared their survival with 620 patients treated with eye enucleation. Different peripheral doses (using the 50% therapeutic isodose) were employed: 50-70 Gy for 24 patients, 45 Gy for 71 patients, 35 Gy for 62 patients.


There was no significant difference in survival between the 35-Gy, 45-Gy and 50– to 70-Gy groups when compared between themselves (p = 0.168) and with the enucleation group (p = 0.454). The 5-year survival rates were: 64% for 35 Gy, 62.71% for 45 Gy, 63.6% for 50–70 Gy and 65.2% for enucleated patients. Clinical variables influencing survival for radiosurgery patients were tumour volume (p = 0.014) and location (median 66.4 vs 37.36 months for juxtapapillary vs peripheral tumours, respectively; p = 0.001), while age and gender did not prove significant. Regarding complications, using 35 Gy led to more than a 50% decrease, when compared with the 45-Gy dose, in the incidence of cataract, glaucoma and retinal detachment. Retinopathy, optic neuropathy and vitreous haemorrhage were not significantly influenced. Blindness decreased dramatically from 83.7% for 45 Gy to 31.4% for 35 Gy (p = 0.006), as well as post-radiosurgery enucleation: 23.9% for 45 Gy vs 6.45% for 35 Gy (p = 0.018). Visual acuity, recorded up to 5 years post-radiosurgery, was significantly better preserved for 35 Gy than for 45 Gy (p = 0.0003).


Using 35 Gy led to a dramatic decrease in complications, vision loss and salvage enucleation, while not compromising patient survival.


Gamma Knife Radiosurgery Ocular melanoma Enucleation 


Conflicts of interest



  1. 1.
    Augsburger JJ, Correa ZM, Freire J, Brady LW (1998) Long-term survival in choroidal and ciliary body melanoma after enucleation versus plaque radiation therapy. Ophthalmology 105:1670–1678PubMedCrossRefGoogle Scholar
  2. 2.
    Cohen VM, Carter MJ, Kemeny A, Radatz M, Rennie IG (2003) Metastasis-free survival following treatment for uveal melanoma with either stereotactic radiosurgery or enucleation. Acta Ophthalmol Scand 81:383–388PubMedCrossRefGoogle Scholar
  3. 3.
    Collaborative Ocular Melanoma Study Group (2001) The COMS randomized trial for iodine 125 brachytherapy for choroidal melanomas III. Initial mortality findings. Arch Ophthalmol 119:969–981Google Scholar
  4. 4.
    De Potter P, Shields CL, Shields JA, Cater JR, Tardio DJ (1994) Impact of enucleation versus plaque radiotherapy in the management of juxtapapillary choroidal melanoma on patient survival. Br J Ophthalmol 78:109–114PubMedCrossRefGoogle Scholar
  5. 5.
    Fakiris AJ, Lo SS, Henderson MA, Witt TC, Worth RM, Danis RP, Des Rosiers PM, Timmerman RD (2007) Gamma-knife-based stereotactic radiosurgery for uveal melanoma. Stereotact Funct Neurosurg 85:106–112PubMedCrossRefGoogle Scholar
  6. 6.
    Furdova A, Slezak P, Chorvath M, Waczulikova I, Sramka M, Kralik G (2010) No differences in outcome between radical surgical treatment (enucleation) and stereotactic radiosurgery in patients with posterior uveal melanoma. Neoplasma 57:377–381PubMedGoogle Scholar
  7. 7.
    Furdova A, Strmen P, Waczulikova I, Chorvath M, Sramka M, Slezak P (2011) One-day session LINAC-based stereotactic radiosurgery of posterior uveal melanoma. Eur J OphthalmolGoogle Scholar
  8. 8.
    Krema H, Somani S, Sahgal A, Xu W, Heydarian M, Payne D, McGowan H, Michaels H, Simpson ER, Laperriere N (2009) Stereotactic radiotherapy for treatment of juxtapapillary choroidal melanoma: 3-year follow-up. Br J Ophthalmol 93:1172–1176PubMedCrossRefGoogle Scholar
  9. 9.
    Modorati G, Miserocchi E, Galli L, Picozzi P, Rama P (2009) Gamma knife radiosurgery for uveal melanoma: 12 years of experience. Br J Ophthalmol 93:40–44PubMedCrossRefGoogle Scholar
  10. 10.
    Mullner K, Langmann G, Pendl G, Faulborn J (1998) Echographic findings in uveal melanomas treated with the Leksell gamma knife. Br J Ophthalmol 82:154–158PubMedCrossRefGoogle Scholar
  11. 11.
    Seregard S, Kock E (1995) Prognostic indicators following enucleation for posterior uveal melanoma. A multivariate analysis of long-term survival with minimized loss to follow-up Acta Ophthalmol Scand 73:340–344Google Scholar
  12. 12.
    Zimmerman LE, McLean IW, Foster WD (1978) Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumour cells. Br J Ophthalmol 62:420–425PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Eduard B. Dinca
    • 1
  • John Yianni
    • 1
  • Jeremy Rowe
    • 1
  • Matthias W. R. Radatz
    • 1
  • Daniel Preotiuc-Pietro
    • 2
  • Paul Rundle
    • 3
  • Ian Rennie
    • 3
  • Andras A. Kemeny
    • 1
    Email author
  1. 1.The National Centre for Stereotactic RadiosurgeryRoyal Hallamshire HospitalSheffieldUK
  2. 2.Department of Computer ScienceUniversity of SheffieldSheffieldUK
  3. 3.Department of OphtalmologyRoyal Hallamshire HospitalSheffieldUK

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