Zusammenfassung
Die Behandlung großer intraokularer Melanome stellt eine therapeutische Herausforderung aufgrund der therapiebedingten Nebenwirkungen dar. Durch eine reine Bestrahlungstherapie ist durch die resultierende Tumornekrose mit zunehmenden radiogenen Nebenwirkungen zu rechnen. Bei anterior gelegenen Aderhaut-Ziliarkörpermelanomen bietet die transsklerale Resektion in arteriellen Hypotonie und bei posterioren Tumoren die Endoresektion über eine Pars-plana-Vitrektomie eine chirurgische Alternativbehandlung. Bei insgesamt 292 Patienten mit großen Ziliarkörper- bzw. Aderhautmelanomen wurde eine chirurgische Resektion des Tumors durchgeführt. 150 Tumoren wurden transskleral reseziert und erhielten anschließend eine adjuvante 106Ruthenium-Brachytherapie und 142 wurden mittels Protonen vorbestrahlt und wurden anschließend durch eine Endoresektion exzidiert. Die mittlere Nachbeobachtungszeit war 3,8 bzw. 2,5 Jahre. Die lokale Tumorkontrolle betrug bei den transskleral resezierten Tumoren 76 % und bei den endoresezierten Tumoren 98 %. Die 5-Jahres-Metastasierungsrate war 28 % und 21 %. Der Augenerhalt war 82 % und 97 %. Die chirurgische Resektion von Ziliarkörper- bzw. Aderhautmelanomen mit adjuvanter Bestrahlung ist bei großen Tumoren die Therapie der Wahl, da bei der Mehrzahl der Patienten mit einem Augenerhalt zu rechnen ist, ohne die tumorebezogenen Risiken zu erhöhen.
Abstract
The treatment of large uveal melanomas poses a therapeutic challenge, due to the expected treatment-related side-effects. After sole radiotherapy the majority of patients are faced with radiogenic complications secondary to the large amount of tumour necrosis. Alternative treatment modalities addressing this issue are transscleral resection in arterial hypotension in anteriorly located tumours and endoresection via pars plana vitrectomy in posteriorly located tumours. A surgical resection treatment was applied in 292 patients with large uveal melanomas. In 150 patients the tumour was treated by transscleral resection and postoperative adjuvant 106ruthenium brachytherapy and 142 patients were treated by primary proton beam irradiation and secondary endoresection. The mean follow-up time was 3.8 and 2.5 years, respectively. Local tumour control was achieved in 76 % and 98 %, respectively. The 5-year metastatic rates were 28 % and 21 % and eye retention was achieved in 82 % and 97 %, respectively. Surgical resection of uveal melanomas with adjuvant radiotherapy is the treatment of choice in cases of large tumours, avoiding enucleation in the vast majority of cases in the long term, without increasing the incidence of tumour-related risks.
Schlüsselwörter
okuläre Tumoren - Retina - Chorioidea - Glaskörper
Key words
choroid - retina - vitreous - ocular tumours
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Prof. Nikolaos E. Bechrakis
Universitätsklinik für Augenheilkunde und Optometrie
Anichstr. 35
6020 Innsbruck
Österreich
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Fax: ++ 43/5 12/50 42 37 22
Email: nikolaos.bechrakis@i-med.ac.at
