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Transpupillare Thermotherapie (TTT) von Aderhautmelanomen

Langzeitergebnisse einer alleinigen TTT mit einem Adapter für einen konventionellen Infrarotlaser

Transpupillary thermotherapy (TTT) for uveal melanomas

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Zusammenfassung

Hintergrund

Zunehmend wird über orbitale Rezidive nach transpupillarer Thermotherapie (TTT) von Aderhautmelanomen berichtet. Gegenstand dieser Arbeit sind unsere Langzeitergebnisse nach alleiniger TTT.

Patienten und Methode

Insgesamt wurden 18 Augen behandelt. Von 10 kleinen und 8 mittelgroßen (bis zu einer maximalen Prominenz von 5,6 mm) waren fünf juxtapapillär, sechs makulär bzw. juxtamakulär und sieben in der mittleren Peripherie gelegen.

Ergebnisse

Nach einer medianen Verlaufsbeobachtungsdauer von 7 Jahren kam es bei zehn Tumoren zu einer vollständigen Tumorregression (Narbe), bei sechs zu einer partiellen Tumorrückbildung (mit einer maximalen Tumorrestprominenz von 2,9 mm). Drei Rezidive am Tumorrand konnten mit neuerlicher TTT bzw. Ruthenium-106-Brachytherapie behandelt werden, bei zwei weiteren war eine Enukleation notwendig. In keinem Fall ist es zu einem orbitalen Rezidiv gekommen.

Schlussfolgerung

Pigmentierte Aderhautmelanome des hinteren Pols (mit Ausnahme makulärer Melanome) bis zu einer Prominenz von 3 mm können mit einer alleinigen Thermotherapie ohne Brachytherapie zerstört werden. Die Gefahr von Rezidiven steigt mit zunehmender Prominenz. Amelanotische und makuläre Melanome sind als relative Kontraindikation für eine TTT anzusehen.

Abstract

Background

An increasing number of orbital recurrences after TTT have been reported; the aim of our paper was to present our long-term results after a maximum follow-up of 8 years and 2 months.

Patients and method

Among 18 eyes, 10 tumors were classified as small, and 8 as medium sized (with a maximum prominence of 5.6 mm): 5 melanomas had a juxtapapillary location, 6 a macular (or juxtamacular) location, and 7 were located in the midperiphery of the fundus.

Results

After a median follow-up of 7 years in seven tumors a complete regression (scar formation) could be achieved, and in six a partial regression (with a maximum residual prominence of 2.9 mm) could be seen. In three patients a recurrence was treated either by another TTT or a Ruthenium-106 plaque; in another two recurrences, enucleation had to be performed. In none of the cases has an orbital recurrence occurred so far.

Conclusion

To prevent recurrences, adequate technique and appropriate selection of patients are mandatory in our opinion (no tumors higher than 3 mm). The higher the tumor prominence, the greater the chance of recurrences. Amelanotic melanomas and macular melanomas seem to respond poorly to thermotherapy.

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Authors and Affiliations

  1. Augenklinik, Medizinische Universität Graz

    G. Langmann, H. Lechner, E. Wenzel, G. Mossböck & W. Wackernagel

  2. Augenklinik, Medizinische Universität, Auenbruggerplatz 4, A-8036, Graz, Österreich

    G. Langmann

Authors
  1. G. Langmann
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  2. H. Lechner
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  3. E. Wenzel
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  4. G. Mossböck
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  5. W. Wackernagel
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Corresponding author

Correspondence to G. Langmann.

Additional information

Teile dieser Publikation wurden anlässlich der Millenniumstagung der Deutschen Ophthalmologischen Gesellschaft in Berlin als Vortrag präsentiert.

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Langmann, G., Lechner, H., Wenzel, E. et al. Transpupillare Thermotherapie (TTT) von Aderhautmelanomen. Ophthalmologe 102, 1162–1167 (2005). https://doi.org/10.1007/s00347-005-1232-4

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  • DOI: https://doi.org/10.1007/s00347-005-1232-4

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