Long‐term outcome of transpupillary thermotherapy as primary treatment of selected choroidal melanoma

Abstract

. Purpose: To evaluate prospectively, on a long‐term range, the clinical outcomes of transpupillary thermotherapy (TTT) as primary treatment of selected choroidal melanoma. Methods: Seventy‐seven eyes of 77 patients affected by small posterior choroidal melanoma were treated with TTT as a sole treatment, using an infrared diode laser at 810 nm according to a standard procedure. Follow‐up was longer than 36 months. Results: Seventeen tumours (22%) were parapapillary (PP) and 60 tumours (78%) were non‐parapapillary (NPP) in location. Mean follow‐up was 55.2 ± 17.9 months in PP tumours and 44.3 ± 23.7 months in NPP tumours. Thirteen (76%) PP tumours and 55 (92%) NPP tumours regressed (P > 0.05). Nine tumours recurred: seven were retreated using Iodine‐125 brachytherapy and two were enucleated (both parapapillary). Four patients (5%) developed liver metastasis and died during follow‐up. Tumour thickness was found to be predictive of recurrence (odds ratio: 4.3). Complications were found in 20 eyes (26%): macular pucker in 11 (14%), macular oedema in three (4%), retinal vein occlusion in six (8%), vitreous and subretinal haemorrhage in two (3%) and neovascular glaucoma in three (4%). PP tumours had more local complications (but this was not statistically significant; P > 0.05). Complications appeared more frequently in tumours treated with more than one TTT session (P = 0.01), and time‐risk to develop intraocular complications seems longer in the PP group, without reaching statistical significance (P = 0.07). Conclusion: TTT may be a clinically effective method for conservative treatment of selected, non‐parapapillary, small posterior choroidal melanoma.

Primary Transpupillary Thermotherapy for Choroidal Melanoma in 391 Cases

“…As seen in Table 2, tumors in the 1995e2000 group were closer to the foveola, explaining the higher rates of decreased visual acuity and poor final visual acuity in this group compared with the 2001e2012 group (Table 3). Other investigators also found a relationship between proximity of the tumor to the fovea and visual prognosis after primary TTT of choroidal 17,18,21,26 and retinal detachment. 10,13,16,18,21,27,28 Although a study comparing TTT with plaque radiotherapy failed to show any visual advantage to TTT, 10 we and some other investigators believe that TTT of certain small choroidal melanomas, especially those located close to but outside the central macula, may be associated with better long-term visual outcome compared with radiotherapy.…”

“…Several prior studies showed initial tumor thickness and tumor basal diameter to be predictive of failure after primary TTT of choroidal melanoma. 17,19,22 In this study, which included tumors up to a thickness of 5.4 mm, multivariate analysis identified thickness and elevation of residual tumor scar after TTT to correlate with tumor recurrence (Table 6). Initial tumor thickness was found to correlate with tumor recurrence if residual tumor thickness after TTT was excluded from analysis (Table 6).…”

Falha a longo prazo no tratamento do melanoma de coróide com termoterapia transpupilar

“…The depth to be reached can limit the method's efficiency, either in primary applications or reapplications (5)(6)(7)(8)(9)(10)(11)(12) .…”

“…More recently, different publications have supported a more cautious approach, and there is disagreement regarding the method's results and complications. The detection of treatment failures (local or distant metastases) depends on the study's follow-up period (6)(7)(8)(9)(10)(11) .…”

Large-spot subthreshold transpupillary thermotherapy for chronic serous macular detachment

“…The use of PDT in the treatment of chronic CCSC has not been without complication, and RPE atrophy and juxtafoveal CNV have been reported after PDT 18,19. Trans-pupillary thermotherapy (TTT) has been advocated in the management of macular lesions, particularly in the treatment of CNV,20 choroidal melanoma,21,22 choroidal hemangioma,23 and CSC 24,25. The advantages of diode laser (810 nm) in the treatment of macular disease are related to low absorption by xanthophyll and poor absorption by hemoglobin (allowing treatment through preretinal and subretinal blood), with low energy delivery, thereby avoiding damaging photoreceptor cells.…”