Abstract

DO.24.05

Therapeutic concepts of uveal melanoma near to the optic nerve

Freistühler M.¹, Akgül H.¹, Flühs D.², Sauerwein W.², Bornfeld N.^1
1Department of Ophthalmology, ²Department of Radiation Oncology, University Duisburg-Essen

Objective: Treatment of juxtapapillary choroidal melanoma near to the optic nerve with brachytherapy using ruthenium-106
Methods: Retrospective evaluation of the radiation protocol and the follow up of patients with uveal melanoma near to the optic nerve. Patients: total n=approx. 4000, study patients: group n=331, inclusion criteria: uveal melanomas near to the optic nerve primary treated with brachytherapy especially using the COB ruthenium-106 applicator produced by the company Bebig.
Results: In 48.9% (n=162) of the included patients a second therapy, in 12.1% (n=40) a third and in 4.2% (n=14) a fourth therapy was necessary. 11.4% (n=38) needed a second brachytherapy, 36.9% (n=122) needed a thermal therapy (TTT Transpupillary-Thermo-Therapy (n=69) or photocoagulation (n=53)). Only in 3.3% (n=11) of all 331 patients included got enucleation in the end. All of them got atrophy of the optic nerve and low visual acuity (nearly all of them < 0.1).
Conclusions: Primary brachytherapy is in half of all cases not enough to destroy the hole tumor. In most of all patients in the end tumor control could be achieved after several and different kind of therapies although atrophy of the optic nerve and loss of vision could not be avoided.

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