Diagnostik und Therapie choroidaler Melanome

 

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Zusammenfassung

Hintergrund: In der Diagnostik der Aderhaut- und Ziliarkörpermelanome gibt es wesentliche Fortschritte in der Bestimmung der Prognose durch Untersuchung zytogenetischer Tumoreigenschaften. Auch die neue TNM-Klassifikation dient der Einschätzung der Überlebenswahrscheinlichkeit in Abhängigkeit der klinisch bestimmbaren Tumorgröße und -ausdehnung.

Material und Methoden: Darstellung der aktuellen diagnostischen und therapeutischen Möglichkeiten des Aderhautmelanoms.

Ergebnisse: Während im Ergebnis der lokalen Strahlentherapie mittels Brachy-, Protonen- und Photonentherapie sowie der Tumorchirurgie meistens eine Organerhaltung möglich ist, bleibt die Überlebenswahrscheinlichkeit im Vergleich zur primären Enukleation aufgrund einer hämatogenen Mikrometastasierung vor Therapiebeginn unverändert.

Schlussfolgerung: Die Prognose der häufigsten intraokularen Tumoren kann gegenwärtig lediglich durch eine frühzeitigere augenärztliche Identifikation und Behandlung verbessert werden.

Abstract

Background: Prognosis evaluation of patients with choroidal and ciliary melanoma has experienced recent progress through tumour sampling and cytogenetic analysis of metastatic risk. By allocating tumor extension, height and linear basal diameter to defined TNM stages, an estimation of prognosis can also be made without invasive tissue sampling.

Methods: Therapeutic strategies of organ preserving irradiation using different sources have clearly come to the forefront.

Results: Due to microscopic haematogenous spreading of tumour cells prior to treatment, the metastatic risk following radiation of any form is not influenced in comparison to primary enucleation.

Conclusion: However, metastatic disease still remains a fatal condition which currently may only be influenced by early detection and treatment of uveal melanomas.

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