gms | German Medical Science

Objective: Comparison of the clinical course of patients with uveal melanomas near the optic nerve concerning tumour localisation, tumour height and primary tumour destructive therapy.

Methods: Retrospective data assessment of 348 patients with an uveal melanoma near the optic nerve and were primary treated with: a)brachytherapy with 106Ru-plaques, b)106Ru-125I-binuclid plaques, c)proton beam irradiation, d)combined treatment modality consisting of brachytherapy with 106Ru-plaques and transpupillary thermotherapy.

Evaluation of the clinical course (mean follow-up 50 months) considering primary tumour destructive treatment, complications, visual acuity, tumour localisation, tumour height.

Results: Primary brachytherapy with 106Ru-125I-binuclid plaques had the worst and primary brachytherapy with 106Ru-plaques had the best results. The combined treatment of brachytherapy and TTT increase the rate of blindness and decrease the rate of tumour recurrence. Using proton beam irradiation tumour recurrence was statistically higher (if safety margin was reduced) and however the decrease of visual acuity developed more slowly it was not statistically better than in the brachytherapy group..

Conclusions: Planning treatment of juxtapapillary uveal melanomas both tumour height and localisation should be considered. However proton beam irradiation had a small benefit in central tumours, the results in visual acuity were the same after manifestation of radiogenic retinopathy. Large uveal melanomas had a poor prognosis in general, especially with temporal localisation.