Prevention and treatment of the toxic tumour syndrome following primary proton beam therapy of choroidal melanomas

Abstract

The aim of this study was to evaluate the efficacy and safety of endoresection for choroidal melanoma to prevent and treat the toxic tumour syndrome (TTS). Material and methods: Thirteen patients who underwent primary proton beam therapy (PBRT) for choroidal melanoma followed by endoresection were evaluated. Main outcome measures were functional and anatomical results, surgical complications, rate of local recurrence, presence or absence of metastatic spread. Results: The median time of the follow-up period was 61.6 months. Six patients with clinical signs of TTS and seven with large tumours to prevent TTS underwent endoresection. Tumour thickness was 5.8 to 9.3 mm (mean: 7.6), the basal diameters were 10.6 to 15.0 mm (mean: 13.4). Preoperative best corrected visual acuity (BCVA) was 6/7.5 to counting fingers and the final BCVA was 6/15 to no light perception, and was better in those treated to prevent TTS (p = 0.01). The most universal early postoperative complication was bleeding from the scleral bed. The most common late postoperative complications were epiretinal membrane formation (30.8%), cystoid macular oedema (23.1%) and silicone oil-induced glaucoma (15.4%). Two (15.4%) patients developed phthisis bulbi, neither developed local recurrence. One patient developed liver metastases. Conclusions: Endoresection for choroidal melanoma is a safe and effective procedure with a high rate of local tumour control. The procedure appears to be useful in the prophylaxis and treatment of TTS after PBRT of choroidal melanoma.

Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review

“…No case of NVG was detected in the other two studies. Despite a 100% globe preservation rate at last follow-up, Kubicka-Trząska et al [ 12 ] reported two cases of phthisis bulbi. Probability of developing RR or radiation optic neuropathy after 24 months was estimated at 27.5% and 29.4%.…”

“…First line therapies for radiation vasculopathy and TTS are anti-VEGF and steroidal intravitreal medications combined with retinal laser photocoagulation [ 12 ]. Among second line therapies, TTT has shown positive results in both prevention and treatment of TTS [ 7 ].…”

“…By contrast, ER must be carefully performed in tumours with LBD larger than 15 mm due to an augmented risk of local surgical complications [ 12 ]. The most dangerous intraoperative complication related to ER is air embolism through vortex veins [ 34 , 35 ], which can occur for tumours of any size.…”

“…Patients undergoing ER for prevention showed tumour thickness ≥7 mm and posterior or equatorial location in all three studies. Kubicka-Trząska et al [12] included only tumours with LBD <15.0 mm and Bechrakis et al [13] excluded tumours with ciliary body and subfoveal infiltration and tumours with circumpapillary growth exceeding half of the optic disc circumference. The studies differed in time interval from radiotherapy to surgery (Table 1).…”

Diagnostic and therapeutic management of patients with ocular melanomas – recommendations of the Polish Society of Oncology

“…• Endoresection -can be performed after prior radiation therapy. The tumor is removed during pars plana vitrectomy [37][38][39].…”