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Endoresektion von großen uvealen Melanomen nach Protonenbestrahlung

Endoresection following proton beam irradiation of large uveal melanomas

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Zusammenfassung

Hintergrund

Große uveale Melanome, die sich in der Nähe der Papille und/ oder der Fovea befinden, haben wegen der zu erwartenden Spätkomplikationen eine ungünstige Prognose bezüglich des Visus- und Bulbuserhaltes. Die Endoresektion dieser Tumoren ist eine neue Behandlungsmodalität, die möglicherweise Vorteile in der Therapie dieser komplizierten Fälle bieten wird.

Patienten und Methode

Bei 32 Patienten mit großen uvealen Melanomen (mittlere Tumor-Prominenz: 9,1 mm, mittleres Tumorvolumen: 0,77 cm3), wurde nach primärer Protonenbestrahlung mit 60 CGE eine Endoresektion über eine Pars plana-Vitrektomie durchgeführt. Der präoperative Visus betrug 0,2 (Median) und die mediane Nachbeobachtungszeit war 12 Monate.

Ergebnisse

Der postoperative Visus betrug nach einer Nachbeobachtungszeit von 12 Monaten 0,12 (Median, mittlerer Visusverlust 0,08). Die Wahrscheinlichkeit der Entwicklung einer Strahlenretinopathie bzw. strahleninduzierten Optikusneuropathie nach 12 Monaten wurde mit 35% bzw. 28% berechnet. Die Wahrscheinlichkeit der Notwendigkeit einer Enukleation in den ersten 12 Monaten betrug 9%. Es fanden sich keine Tumorrezidive. Metastasen traten bei 2 Patienten auf.

Schlussfolgerungen

Bei großen uvealen Melanomen ist die Endoresektion nach vorausgegangener Protonenbestrahlung eine sinnvolle Behandlungsalternative zu der bisher durchgeführten alleinigen Bestrahlung bzw. Enukleation. Sie ermöglicht einen langfristigen Bulbus- und Visuserhalt bei einem hohen Anteil der Patienten.

Abstract

Purpose

Large uveal melanomas located close to the optic nerve and/ or to the fovea have an unfavourable prognosis with regard to visual preservation and eye retention, due to the high incidence of radiation and tumour necrosis induced complications. Endoresection of the tumour after proton beam irradiation, is an alternative approach, aiming to reduce the incidence of ocular morbidity caused by tumour necrosis after sole radiotherapy.

Patients and Methods

32 patients with large uveal melanomas (mean tumour thickness: 9,1 mm, mean tumour volume: 0,77 cc), received a primary proton beam irradiation (60 CGE) and underwent subsequent endoresection via a 3-port pars plana vitrectomy. The median pretreatment visual acuity was 0,2. The mean follow-up was 13,9 months.

Results

The postoperative visual acuity after 12 months was 0,12 (median, mean visual acuity loss 0,08). The probability of developing radiation retinopathy or papillopathy within the first year after treatment was 35% and 28% respectively and the probability of enucleation was 9% within the first postoperative year. No tumour recurrences were observed and 2 patients developed liver metastases.

Conclusions

Endoresection following irradiation of large uveal melanomas located close to the optic nerve and/ or the fovea seems to be a useful and safe alternative to the traditional irradiation or enucleation. The incidence of complications following our approach seems to be lower when compared to radiation alone, where tumour necrosis is a substantial problem.

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Author information

Authors and Affiliations

  1. Augenklinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin

    N. E. Bechrakis, K. M. Kreusel & M. H. Foerster

  2. Klinik für Radioonkologie und Strahlentherapie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin

    S. Höcht

  3. Medizinische Statistik und klinische Epidemiologie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin

    P. Martus

  4. Ionenstrahlenlabor, Hahn-Meitner Institut, Berlin

    J. Heese

  5. Augenklinik, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    N. E. Bechrakis

Authors
  1. N. E. Bechrakis
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  2. S. Höcht
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  3. P. Martus
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  4. K. M. Kreusel
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  5. J. Heese
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  6. M. H. Foerster
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Correspondence to N. E. Bechrakis.

Additional information

Vortrag gehalten auf der 100. Tagung der Deutschen Ophthalmologischen Gesellschaft in Berlin.

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Bechrakis, N.E., Höcht, S., Martus, P. et al. Endoresektion von großen uvealen Melanomen nach Protonenbestrahlung. Ophthalmologe 101, 370–376 (2004). https://doi.org/10.1007/s00347-003-0911-2

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