Аннотация:The objective of the present study was retrospective
evaluation of results of Gamma Knife surgery (GKS)
for uveal melanoma performed in 8 European Gamma
Knife centers (Bucharest, Florence, Istanbul, Moscow,
Prague, Saint Petersburg, Sheffield, and Zurich), which
agreed to participate and provided required information.
Study design presumed collection of the various data
(62 investigated variables) on individual patients with
creation of the integrated database for further statistical
analysis. Primary end-points were overall survival, local
tumor control, eye retention rate, and morbidity during
follow-up. Secondary end-points were tumor response,
preservation of visual function on the affected eye, and
incidence of metastatic disease after GKS.
In total 349 cases were collected. All patients were treated
between July 2001 and October 2015. The stage of treated
tumors corresponded to I, IIA, IIB, and IIIA in 26%, 43%,
23% and 7% of cases, respectively. Eye fixation was
attained with retrobulbar anesthetic blocking in 65% of
cases or suturing of rectus muscles in 24% of cases; in dose was 30 Gy (range, 25-30 Gy), median maximal dose
was 50 Gy (range, 30-80 Gy), median maximal dose to the
ipsilateral optic nerve was 8.7 Gy (range, 0.7 – 61.2 Gy). In
23 patients GKS was done before planned eye-preserving
endoresection of the tumor. Follow-up information was
available in 314 cases and median length of follow-up was
40 months (range, 1-132 months).
Actuarial survival rates at 3 and 5 years after GKS were
91% and 89%, respectively. Crude tumor control rate
was 98%. Complete response was noted in 19% of cases,
partial response in 46% of cases. Crude eye-retention rate
was 95.5%. In overall 13 enucleations were done owed to
tumor progression (5 cases), complications (2 cases), or
unknown reasons (6 cases). Complications were noted
in 67% of patients, and exudative retinal detachment
(15%), cataract (13%), neovascular glaucoma (11%) and
retinopathy (11%) were the most common. The risk of loss
of the useful vision on the affected eye during follow-up
after GKS was 40%. Suturing of the extraocular muscles
for eye fixation during irradiation and two-staged treatment
(GKS followed by planned endoresection of the tumor) were
associated with significantly lower risk of complications
and visual loss on the affected eye. Distant metastases after
treatment were disclosed in 10% of patients.
In conclusion, GKS seems effective treatment option for
management of uveal melanoma at early stage of disease.