RESULTS OF PREOPERATIVE RADIOTHERAPY IN UVEAL MALIGNANT MELANOMA

Abstract

Certain researches have shown an increase in metastatic disease during the first two or three years after enucleation as a treatment of choroidal malign melanomas, and explained that this peak was a result of micrometastasis at the time of the surgical maniplations and the change in the immune status of the patient because of the operation. In this study, 2000 cGy external radiation was given preoperatively, on the area of orbita, in 400 cGy daily fractions to 40 patients who had choroidal malign melanomas for the purpose of reducing the dissemination of malign cells after enucleation. When we compare this treatment group with the retrospective control group of 75 patients who had only enucleation as a treatment, in the first group distant metastases over five years after treatment were significantly reduced (In the treatment group % 5.8, in the control group % 33.3 and p< 0.01) and survival were longer. Distant metastases during the first three years were less (in the treatment group % 10, in the control group % 14.6), but not significant (p> 0.05).

Keywords

• Choroideal
• malign melanomas
• Preoperative External Radiotherapy

Üveal Malign Melanomlarda Preoperatif Radyoterapinin Sonuçları

Abstract

Yapilan bazi arastirmalar, koroidea malign melanumunda tedavi olarak entikleasyon uygulanmasindan sonraki ilk birkac yil i¢gerisinde uzak metastaz oraninin arttigini géstermis, ve bu durum, operasyon sirasindaki travmaya bagh mikrometastazlar ve operasyon nedeniyle hasta direncinde azalma, ile aciklanmistir. Yaptigimuz galigsmada postoperatif malign hücre yayilimini azaltmak dustncesinden yola cikarak uveal malign melanoma sahip 40 hastaya preoperatif olarak ginde 400cGy’den total 2000 cGy eksternal orbital isinlama yaptuk. Bu hastalarn retrospektif olarak incelenen, sadece enukleasyon yapilmis 75 hastalik kontrol grubu ile karsulastirdifimizda, tedavi grubunda 5 yilin tizerindeki yasamda gértilen metastaz orani istatistiksel olarak anlamh dlctide daha az (Tedavi grubunda % 5.8, kontrol grubunda % 33.3 ve p< 0.01) ve tahmini yasam streleri de daha yuksek olarak bulundu, ilk 3 yilda gérilen metastaz oram daha az bulunmasina ragmen (Tedavi grubunda % 10, kontrol grubunda % 14.6) istatistiksel olarak anlamli degildi (p> 0.05).

Keywords

• Koroideal
• Malign Melanoma
• Preoperatif Eksternal Radyoterapi.

References

1. 1 Augsberger JJ Eagle RC Jr Chiu M Shields JA : The effect of pre-enucleation N radiotherapy on mitotic activity of choridal and cliary body melanomas, Opht- halmology 94 : 1627, 1987.
2. 2 Burns RP Allen CV Fraunfelder FT : X-ray therapy of experimental melanoma of the hamster eye, Am J Ophthalmol 1969; 88 : 328-336,
3. 3 Char DH Phillips TL ; Pre-enucleation irradiation of uveal melanoma, British J of Opthalmol 1985; 68 : 177-179.
4. 4 Char DH Philips TL Andejeski Y Crawford Jb, Kroll S : Failure of pre-enucle- ation radiation to decrease uveal melanoma mortaltly, American J of Ophtal- mol 106 : 21-26, July, 1988.
5. 5 Char DH : Management of small choroidal melanoma, Surv .Ophtalmol 1078; 5. 22:377-86.
6. 6 Char DH Philips TL : The potential for adjuvant radiotherapy in choridal me- lanoma, Arch Ophtalmol Vo 100 Feb 1882.
7. 7. Fournier GA Saulenes AM Seddan Jm et al : The effects of preenucleation ir- radiation on the development of metastasis from intraocular Greene melanoma in hamsters, Am J Ophtalmol 1985; 100 : 680-677
8. 8. Jensen AO : Malignant melanomas of the human uvea : 25 years follow up of cases in Deninark 1943-1952 Acta Ophthalmol 1982; 60 : 161-182.

9. 9. Kenneally C2 Farber M6 Smith ME Devineni R : Invitro melanoma cell growth after pre-enucleation radiation therapy, Arch Ophthalmo-Vol 106, Feb, 1988.
10. 10. Lehfeld L Is enucleation indicated in early cases of intraocular malignant melanoma? A report of two cases, Am J Ophthalmol 1942; 25: 199-202.
11. 11. Lommatzch P Dietrich B The effect of orbital irradiation on the survival rate of patients with choroidal melanoma, Ophthalmologica 1976; 173:48
12. .12. Mc Lean IW Foster WD Zlmmerman LK et al: Inferred natural history of uveal melanoma : Invest ophthalmol, Vis Sci 1980; 19 : 760-770
13. 13. Niederhorn VY tes metastasis of intraocular melanomas in mice, Invest Ophthalmol Vis Sci 1984;25: 1080-1086.
14. 14 Niederkorn JY Enucleation induced metastasis of intraocular melanomas in mice, Ophthalmology 1984; 01. 692-700,
15. 15. Rousseau A Deschenes J Pelleticr 6 et al : Malignant melanoma pre-enucleation radiotheraby Ophthalmology 1982; 89 (Suppl) : 86.
16. 16 Ravio J : Uveal melanoma in Finland. An epidemiolopical, clinical, histological and prognostic study, Acta Ophthalmo! 133 ; 5, 1977.
17. 17 Sanborn GE Ngyuen P Gamel J Niederkorn JY : Reduction of enucleation-induced metastasis in intraocular melanoma by periorbital irradiation, Arch Ophthalmol 1987; 105 ; 1260-1264.
18. 18 Simon RM: Design and conduct of clinical trials, CANCER Principles & Practice of Oncology Chapter 19414-415
19. 19 (De vita VT Jr, Hellman S, Steven A. Rosen- 19. Stallard HB : Malignant melanoblastoma of the choroid, Mod Probl Ophthalmol berg). 1968;7 16-30.
20. 20. Vogel MH : Treatment of malignant choroidal melanomas with photocoagula- tion, Am J Ophthalmol 1972; 74: 1-11.
21. 21 Wilson RS Fraunfelder FT : «No-touch» cryosurgical enucleation, a minimal trauma technique for eyes harboring intraocular malignancy, Trans Am Acad Ophthalmol 1978; 85 : 1170.
22. 22 Zimmerman LE Mc Lean IW Foster WD : Does enucleation of the eye containing a malignant melanoma prevent or accelerate the dissemination of tumour cells, Br J Ophthalmol 1978: 62 : 420-425.
23. 23. Zimmerman LE Mc Lean IW Foster WD : Statistical analysis of follow-up data concerning uveal melanomas, and the influence of enucleation, Ophthalmology 1980; 87 : 557-564.
24. 24 Zimmerman LE ;: Metastatic disease from uveal melanomas : A review of current concepts with comments concerning future research and prevention, Trans Ophthalmol Soc UK 1980; 100 : 34 54