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Gamma-Knife-Radiochirurgie in der Ophthalmoonkologie

Gamma knife radiosurgery in ophthalmic oncology

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Zusammenfassung

Hintergrund

Ziel dieser retrospektiven Studie ist die Präsentation der Visusergebnisse, Komplikationen, adjuvanten Therapien, lokalen Tumorkontrollrate und des Augenerhalts nach primärer Gamma-Knife-Radiochirurgie (GKR) bei uvealen Melanomen.

Material und Methode

Die Krankengeschichten von allen mit GKR zwischen Juni 1992 und Mai 2010 an der Univ.-Augenklinik Graz wegen eines Aderhautmelanoms behandelten PatientInnen wurden ausgewertet. Der initiale bestkorrigierte Visus, der Zeitpunkt des Visusverlustes, PatientInnen‑, Tumor- und Behandlungsparameter, Komplikationen sowie adjuvante Therapien wurden erhoben und mittels deskriptiver Statistik ausgewertet. Der Nachbeobachtungszeitraum endete 2018.

Resultate

Es wurden 189 PatientInnen im definierten Zeitraum mit dem Leksell-Gamma-Knife behandelt; 177 konnten in die Studie aufgenommen werden. Die mediane Nachbeobachtungszeit betrug 51,9 Monate; 164 (92,6 %) PatientInnen hatten in Folge eine oder mehrere GKR-assoziierte Komplikationen. Bei 100 (56,4 %) PatientInnen waren eine oder mehrere adjuvante Therapien erforderlich. Über den Nachbeobachtungszeitraum hinweg konnte eine Tumorkontrollrate von 94,4 % (167 PatientInnen) erreicht werden; 10 (5,6 %) PatientInnen hatten ein Rezidiv 3,1 Monate bis 60,7 Monate postinterventionell. Eine Metastasierung wurde bei 21 (11,8 %) PatientInnen festgestellt, 5,3 bis 136,2 Monate postinterventionell.

Schlussfolgerung

GKR ist eine vielversprechende Therapieoption uvealer Melanome mit einer hohen Tumorkontrollrate. Sie ist minimalinvasiv und benötigt keine Voroperation. Die Behandlung nimmt lediglich einige Stunden in Anspruch und kann tagesklinisch durchgeführt werden. Der steile Dosisabfall sowie die physikalischen Merkmale des Gamma-Knife eignen sich gut für die Therapie uvealer Melanome mit ihren speziellen radiobiologischen Merkmalen.

Summary

Background

The aim of this retrospective study was to present the results of visual acuity, complications, adjuvant therapy, local tumor control rate and eye preservation after gamma knife radiosurgery (GKR) of uveal melanoma.

Material and methods

The disease histories of all patients treated by GKR between June 1992 and Mai 2010 at the Department of Ophthalmology, University Hospital Graz for uveal melanoma were analyzed. The initial best corrected visual acuity, the timing of visual deterioration, patient, tumor and treatment parameters, complications and adjuvant therapies were collated and analyzed using descriptive statistics. The follow-up observational period ended in December 2018.

Results

A total of 189 patients were treated with the Leksell gamma knife within the defined timeframe. Of the patients 177 could be included in this study. The mean follow-up time was 51.9 months. Of the patients 164 (92.6%) developed complications associated with GKR. In 100 (56.4%) patients 1 or more adjuvant treatments were necessary. Throughout the follow-up observational period a tumor control of 94.4% (167 patients) could be achieved. Recurrences occurred in 10 (5.6%) patients, 3.1–60.7 months after GKR. Metastases were detected in 21 (11.8%) patients within 5.3–136.2 months after GKR.

Conclusion

The GKR procedure is a promising treatment option for uveal melanoma providing a high tumor control rate. It is minimally invasive and no prior surgery is necessary. The treatment takes only a few hours and can be carried out in an outpatient setting. The physical characteristics of the gamma knife and the steep dose decay are well-suited for the treatment of uveal melanoma with its special radiobiological features.

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  1. Universitäts-Augenklinik, Auenbruggerplatz 4, 8036, Graz, Österreich

    Bernhard Steiner, Werner Wackernagel, Lisa Vajda, Thomas Georgi & Gerald Langmann

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  1. Bernhard Steiner
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Correspondence to Bernhard Steiner.

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B. Steiner, W. Wackernagel, L. Vajda, T. Georgi und G. Langmann geben an, dass kein Interessenkonflikt besteht.

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Steiner, B., Wackernagel, W., Vajda, L. et al. Gamma-Knife-Radiochirurgie in der Ophthalmoonkologie. Spektrum Augenheilkd. 34, 100–106 (2020). https://doi.org/10.1007/s00717-020-00447-5

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