ORGAN-PRESERVING TREATMENT OF CHOROIDAL MELANOMA.

Abstract

Introduction: uveal melanoma (UM) among primary intraocular malignant neoplasms accounts for up to 90%, among oncoophthalmological pathology - 25%, and among melanomas of other localization - 15%. The most frequent localization of UM is the choroid (85-88%). At present, the main treatment of UM is organ-sarving, which can be in the form of laser surgical techniques (photo- and laser coagulation, photodynamic therapy, thermotherapy); contact (brachytherapy) and remote (irradiation with an electron, narrow proton beam) radiation therapy; stereotaxic radiosurgery (cyber-knife and gamma-knife); surgical interventions (exoresection and endoresection); cryodestruction and their combinations. Purpose: to study the effectiveness of treatment of choroidal melanoma (MC) with transpupillary thermotherapy according to the developed technique, both as monotherapy and in combination with Sr90/It90 brachytherapy. Material and methods: the transpupillary thermotherapy (TTT) was performed once a day, every day, for 4 consecutive days on an ophthalmic coagulator "Iridis Quantel medical" (France) using a three-mirror Goldman or Meinster PRP lens (165, WF) with a wavelength of 810 nm in a continuous mode of radiation with a power from 200 mW to 1800 mW, with a light spot diameter of 1.25-4.0 mm, an exposure of 60 s. In the form of monotherapy, TTT was performed in 88 patients with small stage T1 MC (prominence - up to 3.0 mm, base diameter - up to 12.0 mm) and in combination with Sr90/It90 brachytherapy in 76 patients in stages T1-T4. There were 110 (67.1%) women, 54 (32.9%) men. The average age of the patients was 55.9 (SD12.8) years old, the minimum age was 21 years old, the maximum is 82 years old. The right eye was affected in 48.1% (79 patients), the left - in 51.9% of cases (85 patients). Results: a positive result of the treatment of small stage T1 MC according to the developed TTT method was obtained in 81 (92.05%) patients, negative - in 7 (7.95%) patients. Out of 81 patients with a positive result of treatment, complete scarring of the tumor was achieved in 81.5%, partial - in 18.5% of cases. Among MC stages T1-T4, a positive result of treatment was obtained in 67 (88.2%) patients, a negative one - in 9 (11.8%). Out of 67 patients with a positive result of treatment, complete scarring of the tumor was achieved in 88.1%, partial - in 11.9% of cases. Conclusions: the combination of TTT according to the technique developed by us with Sr90/It90 brachytherapy made it possible to obtain high efficiency (88.2%) of treatment of MC stages T1-T4. The high efficiency (92.05%) of the treatment of small MC (prominence - up to 3.0 mm, diameter of the base - up to 12.0 mm) according to the TTT method developed by us allows us to offer it as a monotherapy for such tumors.