Stereotactic radiosurgery of large uveal melanomas with the gamma-knife

Ophthalmology. 2000 Jul;107(7):1381-7; discussion 1387-8. doi: 10.1016/s0161-6420(00)00150-0.

Abstract

Objective: To present our experience with the Gamma-knife in treating large uveal melanomas with stereotactic radiosurgery.

Design: Prospective, noncomparative, interventional case series.

Participants: Fifty-eight patients with unilateral uveal melanomas were treated from 1996 through 1999 with stereotactic radiosurgery using the Gamma-knife. From these we report the results of 35 patients who had a follow-up of more than 1 year after irradiation.

Intervention: Stereotactic radiosurgery with the Gamma-knife.

Main outcome measures: Tumor control, maximum apical tumor height, eye retention rate, and visual acuity.

Results: In 34 eyes (97%), local tumor control was achieved. The maximum apical tumor height decreased from a median of 9.1 mm (95% confidence interval [CI], 3.2-13.9 mm) before treatment to 6.2 mm (95% CI, 2.1-11.9 mm) at 1 year after treatment (P<0.001, paired t test). The tumor volume decreased from a median of 0.8 cm(3) before treatment to 0.5 cm(3) 1 year after treatment (P<0.001, paired t test). Two eyes required enucleation (one radiation failure, one secondary glaucoma). The median visual acuity decreased from 20/60 (95% CI, hand movement [HM] to 20/20) before treatment to 20/200 (95% CI, HM to 20/30) at 1 year after treatment (P = 0.001, paired t test).

Conclusions: Stereotactic radiosurgery using the Gamma-knife is an alternative to enucleation in treating large uveal melanomas. The visual function may be preserved in selected cases.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Melanoma / diagnosis
  • Melanoma / surgery*
  • Middle Aged
  • Orbit / pathology
  • Prospective Studies
  • Radiosurgery / methods*
  • Treatment Outcome
  • Uveal Neoplasms / diagnosis
  • Uveal Neoplasms / surgery*
  • Visual Acuity