Ten-year results of transscleral resection of large uveal melanomas: local tumour control and metastatic rate

Abstract

TSR is an alternative to enucleation for the treatment of large uveal melanomas. Results should improve with better patient selection and more effective methods of adjuvant radiotherapy.

Transscleral resection without hypotensive anaesthesia vs iodine-125 plaque brachytherapy in the treatment of choroidal melanoma

“…We already know that large choroidal tumours with extension to ciliary body are more difficult to treat and thus have an increased risk of local recurrence and metastasis. 13,15,16 Similar rates of metastasis after TSR have been described. 13,16 Some variables associated with metastasis have been identified: tumour thickness, extraocular spread, local recurrence, largest basal diameter416 mm, lack of adjuvant brachytherapy, and secondary enucleation.…”

“…Large basal diameter416 mm and lack of adjuvant brachytherapy, between others, were identified as common risk factors for local recurrence after TSR. 13,14 In our study we did not find any significant differences in local recurrence rates between the TSRWH and IBT groups at 5-year follow-up (5.7 vs 10.5%). Moreover, no local recurrences were observed in eyes treated with TSRWH plus adjuvant brachytherapy (17 of 19 eyes).…”

“…According to some studies, the local recurrence rates at 5 years after treatment may vary from 7 to 24% after TSR with adjuvant brachytherapy, and between 5 and 10% after IBT. [7][8][9][10][11][12][13][14][15] In their case-control study, Kivelä et al 7 found a 35% local recurrence rate for TSR vs only 5% for IBT; importantly, however, when adjuvant brachytherapy was added, local recurrence decreased to 15%. Puusaari et al 8 reported a 5-year local recurrence rate of 41% after TSR but only 7% after IBT in large melanomas.…”

“…13,16 Some variables associated with metastasis have been identified: tumour thickness, extraocular spread, local recurrence, largest basal diameter416 mm, lack of adjuvant brachytherapy, and secondary enucleation. 13,16 …”

Retrospective Evaluation of Patients With Uveal Melanoma Treated by Stereotactic Radiosurgery With and Without Tumor Resection

“…However, because of the concerns of potential tumor cell dissemination during surgery and residual melanoma cells in the scleral bed, resection has been combined with irradiation. 10,11 Radiotherapy of large tumors seems to be associated with increased longterm complications, such as proliferative retinopathy with secondary glaucoma, toxic tumor syndrome, or persistent exudative retinal detachment leading to visual loss or enucleation. 12,13 Therefore, we planned to investigate the effectiveness of a combined radiotherapeutic and surgical treatment of UM not suitable for treatment with ruthenium plaques owing to their size or location.…”