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Klin Monbl Augenheilkd 2011; 228(4): 277-283
DOI: 10.1055/s-0031-1273207
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Langzeitverlauf 10 Jahre nach transpupillarer Thermotherapie (TTT) kleiner, posteriorer maligner Aderhautmelanome

Long-Term Follow-Up 10 Years after Transpupillary Thermotherapy (TTT) for Small, Posterior Located Malignant Melanomas of the ChoroidB. M. Stoffelns1 , K. Schoepfer1 , J. Vetter1 , A. Mirshahi1 , H. Elflein1
  • 1Augenklinik der Universitätsmedizin, Johannes Gutenberg-Universität, Mainz
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Publication History

Eingegangen: 12.9.2010

Angenommen: 13.9.2010

Publication Date:
11 April 2011 (online)

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Zusammenfassung

Hintergrund: Auswertung von Langzeitergebnissen der transpupillaren Thermotherapie (TTT) zur Primärbehandlung kleiner maligner Aderhautmelanome. Patienten und Methoden: In einer prospektiven, nicht randomisierten Interventionsstudie wurden 26 Augen mit kleinen posterioren malignen Aderhautmelanomen (zentral des Äquators gelegen mit einer Basis ≤ 12 und Prominenz ≤ 4,5 mm) im Zeitraum 1/1998 bis 10/1999 mit transpupillarer Thermotherapie nach Standardprotokoll behandelt und über mehr als 10 Jahre nachkontrolliert. Ergebnisse: 13 Männer und 13 Frauen wurden mit TTT behandelt (Altersmedian 64 Jahre). Die Tumorausgangsprominenz betrug im Median 2,45 mm (0,8 – 4,5 mm). Die Nachuntersuchung 10 Jahre postoperativ ergab nach im Median 1,4 TTT-Behandlungen eine komplette Tumorregression ohne Rezidiv in 16 / 26 Augen, eine primäre lokale Tumorkontrolle mit späterem Rezidiv in 6 / 26 Augen und fehlende primäre Tumorkontrolle in 4 / 26 Augen. 2 Patienten verstarben im Beobachtungszeitraum tumorbedingt mit Lebermetastasierung. 14 Augen (vorwiegend bei Tumorlage am hinteren Pol und nach mehr als einer TTT-Behandlung) entwickelten okuläre Komplikationen: Makular Pucker in 8, Makulaödem in 6, choroidale Neovaskularisationen in 4 und posteriore Synechien mit Irisatrophie in einem Auge. Schlussfolgerung: Maligne Aderhautmelanome, die mit TTT als alleinigem Therapieverfahren behandelt wurden, zeigen im Langzeitverlauf hohe Raten von lokalen Tumorrezidiven und okulären Komplikationen. Ein enges Monitoring für alle so behandelten Patienten ist daher lebenslang zwingend notwendig.

Abstract

Background: The aim of this study was to evaluate the long-term results of transpupillary thermotherapy (TTT) for small malignant choroidal melanomas. Patients and Methods: In the time period 1/1998 to 10/1999 in a prospective non-randomised analysis 26 eyes with small malignant melanomas (located posterior to the equator with base ≤ 12 and thickness ≤ 4.5 mm) were primary treated with the TTT standard protocol (follow-up over a time span of at least 10 years). Results: Thirteen women and thirteen men (mean age: 64 years) underwent TTT. The mean preoperative tumour thickness was 2.45 mm (0.8 – 4.5 mm). Ten years postoperatively tumour regression without recurrence after 1.4 treatment sessions (mean) was achieved in 16 / 26 eyes, primary regression followed by tumour regrowth in 6 / 26 eyes, and primary failure of tumour regression in 4 / 26 eyes. Two patients died on liver metastasis. Ocular complications (with preference in posterior tumours after multiple TTT sessions) were observed in 14 eyes: macular pucker in 8, macular oedema in 6, choroidal neovascularisation in 4 and posterior synechia with iris atrophy in one eye. Conclusions: Choroidal melanomas treated with TTT as a stand-alone procedure need a close monitoring since these tumours developed a significant rate of local recurrences and ocular side-effects in the long run.

Schlüsselwörter

malignes Aderhautmelanom - transpupillare Thermotherapie - Langzeitverlauf - Tumorrezidive - okuläre Komplikationen

Key words

malignant choroidal melanoma - transpupillary thermotherapy - long-term follow-up - tumour reccurrence - ocular side-effects

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PD Dr. Bernhard Stoffelns

Augenklinik der Universitätsmedizin, Johannes Gutenberg-Universität

Langenbeckstrasse 1

55131 Mainz

Phone: ++ 49/61 31/1 77 1 33

Fax: ++ 49/61 31/1 76 6 20

Email: bernhard.stoffelns@unimedizin-mainz.de