Российский офтальмологический журнал (Oct 2018)
Indications for enucleation after uveal melanoma brachytherapy
Abstract
Purpose: to analyze indications for enucleation in uveal melanoma (UM) patients after brachytherapy (BT). Material and methods. 52 patients with UM (31 females and 21 males) aged 25 to 74 years (mean age 53.2 ± 12.3) underwent an enucleation after a previously administered BT. Tumor sizes before BT were 6.1 ± 2.1 (1.2-11) mm in thickness and 13.0 ±2.9 (6-19) mm in diameter. Immediately before enucleation, they were 5.3 ± 3.4 (1-17) mm and 12.4 ± 3.6 (5-20) mm respectively. The time span between BT and enucleation varied from 2 to 103 months (median, 25 months). 40 patients (77 %) had choroidal localization of UM (of these,16 had juxtapapillary localization), 10 patients (19.2 %) had ciliochoroidal localization, and 2 patients (3.8 %) had UM in the anterior areas of the eye (iris and ciliary body). Results. In more than a half of the patients (30 patients, or 58 %) tumor regrowth was detected 5-96 months after BT. The second frequent cause for enucleation was neovascular glaucoma found in 21 patients (40 %). Extraocular extension of UM, identified in 12 patients (23 %), took place 3-82 months after BT and turned out to be the third complication as far as frequency of occurrence is concerned. Conclusion. Tumor regrowth remained to be the main cause for secondary enucleation in UM patients after BT. As a matter of fact, complications that can require immediate enucleationmay develop at any time after BT (although the peak falls upon the first 2 years after BT. This fact confirms the need of lifelong follow-up of such patients. Hence, unfounded extension of indications for BT may result in ineffective prolongation of local treatment, a number of radiation complications requiring immediate secondary surgical treatment // Russian Ophthalmological Journal, 2016; 4: 46-51. doi: 10.21516/2072-0076-2016-9-4-46-51.
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