Treating choroidal melanoma by plaque radiotherapy combined with transpupillary thermotherapy

Abstract

Objective To observe the therapeutic efficacy and complications of plaque radiotherapy (PRT) combined with transpupillary thermotherapy (TTT) on choroidal melanoma (CM). Methods Thirty unilateral CM patients (30 eyes, including 15 males and 15 females) were treated by PRT and TTT.The visual acuity ranged from 0. 1 to 0. 8 with an average of 0. 3 ± 0.2. The largest base diameter of tumor ranged from 6. 8 mm to 17. 9 mm with an average of (11.3±2.8) mm;The tumor height ranged from 3.9mm to 10.6 mm with an average of (7.2±2.4) mm. The criteria of controlled local tumor: based on B-scan ultrasound measurement, the tumor was considered as growing if tumor height increased 2 mm or tumor largest base diameter increased 250 μm, otherwise the tumor was considered controlled. The follow-up ranged from 15 to 57 months with an average (33.01 ± 9. 81) months. The local tumor control rate,enucleation rate and visual acuity, complications after treatment were observed. Results The tumor largest base diameter after treatment ranged from 4.6 mm to 17.0 mm with an average (9.79±3.35) mm, which had statistically significant difference(t=2. 195,F=0.49;P=0. 032) with that before treatment. The tumor height after treatment ranged from 2.7 mm to 11.9 mm with an average (5.19±2.57) mm, which had statistically significant difference(t = 2. 069, F= 0. 018;P = 0. 0435 ) with that before treatment. At the end of follow up, the tumor largest diameter and height increased in two eyes respectively compared with those before treatment. Local tumor control rate was 86.7 %. Three eyeballs were enucleated after treatment, the enucleation rate was 10. 0%. The visual acuity remained unchanged in 12 eyes, improved in one eye and decreased in 17 eyes. Treatment complications included radiation retinopathy in 12 eyes (40.0%),secondary retinal detachment in three eyes (10. 0 % ), secondary glaucoma in one eye (3.3 % ), cataract in four eyes (13.3%) and dry eye syndrome in five eyes (16.7%). Conclusion PRT combined with TTT is an effective therapy for choroidal melanoma with less complications. Key words: Choroid neoplasms/radiotherapy; Melanoma/radiotherapy; Iodine/therapeutic use; Hyperthermia, induced