[Treatment of choroidal melanoma with X-ray knife]

To detect and analyze the therapeutic effects of X-ray knife for treatment of choroidal melanoma with the fixation of the eyeball.

The average size of the tumors in 16 eyes of 16 cases was 11.8 mm x 10.0 mm x 4.5 mm. The eyeballs were fixed with four rectus retractable sutures under local anesthesia (no use of retrobulbar injection). The superior and inferior rectus sutures penetrated the upper and lower lids at the middle part of fornixes, and the four sutures were anchored at the positions: above the eyebrow, inferior orbital rim, root of nose and lateral orbital rim respectively and deep to the fascia. A stereotactic linear accelerator, Vrianc 2100 C, was used for the radiosurgery, with an average marginal dose 23.4 Gy. The mean follow-up time was 18.5 months.

The tumors in 7 cases (43.8%) shrinked notably during 6 - 12 months after therapy. In the postoperative 1 - 2 years, the tumors in 11 eyes (68.8%) were decreased in size, among them, in 4 eyes only a flat scar remained and in 3 eyes the shrinkage was not significant. Enucleation was performed in 3 patients because of a little increase in size. The total local control rate was 81.3%. There were no marked side effects except small hemorrhages in or under the retina. Fixations of all eyeballs were very stable, and the orientation of radiotherapy was accurate.

The therapeutic effects of choroidal melanoma with X-ray knife are quite good, and no significant complications are found. There is a higher rate of local control. The fixation of eyeball with four rectus sutures penetrating eyelids is very stable and reliable.