Summary
The functional results after treatment of uveal melanomas are dependent on their size and location within the eye. Large tumours have an increased ocular morbidity due to the expected radiogenic side-effects, in addition to the ocular burden that results from increased tumour regression and necrosis related deposition of cellular and cytokine by products. To address these issues combined radiotherapeutical-surgical techniques have been developed, that result in both increased local tumour control and decreased ocular side-effects. In this overview 292 patients treated by either transscleral resection in general hypotension with adjuvant ruthenium-106 brachytherapy or by proton beam irradiation and subsequent endoresection where analysed. The 5-year mortality varied between 21 and 28%. The enucleation rate was 3 and 18% and the local recurrence rate was 2 and 24% in patients treated by ab interno endoresection or ab externo transscleral resection respectively. In patients treated by transscleral resection there was a correlation between recurrence rate and tumour metastasis. The recurrence rate could be reduced to a minimum (2%) when combined with preoperative proton beam irradiation. A combined irradiation- surgical procedure seems to be required in order to reduce treatment related side-effects.
Zusammenfassung
Die funktionellen Ergebnisse der Behandlung von Aderhautmelanomen ist abhängig von deren Größe und Lage innerhalb des Auges. Große Tumoren haben eine erhöhte okuläre Morbidität wegen der zu erwartenden radiogenen Nebenwirkungen. Hinzu kommt die okuläre Belastung durch die vermehrte Anhäufung von Tumorzerfallprodukten durch den Tumorabbau und die Tumornekrose. Um diese Problematik zu adressieren sind kombinierte strahlentherapeutisch-chirurgische Verfahren entwickelt worden, die sowohl eine sehr gute Tumorkontrolle als auch eine reduzierte okuläre Morbidität zur Folge haben. In dieser Übersichtsarbeit werden 292 Patienten zusammengefasst, bei denen entweder eine transsklerale Resektion in arterielle Hypotonie mit anschließender Ruthenium-106 Brachytherapie oder eine Protonentherapie mit anschließender Endoresektion durchgeführt wurde. Die 5-Jahres Überlebenswahrscheinlichkeit der Patienten schwankte zwischen 21 und 28%. Die Enukleationsraten betrugen 3 und 18% und die lokale Rezidivraten 2 und 24% bei ab interno Endoresektion und ab externo Resektion entsprechend. Bei Patienten deren Tumor ab externo transskleral reseziert wurde fand sich eine Korrelation zwischen erhöhter Rezidivrate und Mortalität. Die Rezidivrate konnte mit einer präoperativen Protonenbestrahlung auf ein Minimum (2%) reduziert werden. Ein kombiniertes strahlentherapeutisch-chirurgisches Vorgehen scheint unter dem Lichte dieser Daten unabdingbar zu sein.
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Bechrakis, N., Blatsios, G., Schmid, E. et al. Die Behandlung von großen Aderhautmelanomen durch chirurgische Exzisionsverfahren. Spektrum Augenheilkd. 24, 17–22 (2010). https://doi.org/10.1007/s00717-010-0380-3
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DOI: https://doi.org/10.1007/s00717-010-0380-3