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Which choroidal melanoma should be treated with primary transpupillary thermotherapy? Our experience from 78 patients
Andrey A Yarovoy1, Dzhavid A Magaramov, Evgeniya S Bulgakova
1Ocular Oncology Department, The S. Fyodorov Eye Microsurgery Complex, Moscow, Russia. yarovoyaa@yandex.ru
Purpose:
To report the outcomes of primary transpupillary thermotherapy (TTT) for choroidal melanomas.
Methods:
A total of 78 patients were treated with TTT. Tumor thickness was up to 3.6 mm (mean 2.05 mm), follow-up 2.5-108 months (mean, 32.8 months). The main outcome measures were local control, enucleations, tumor recurrences, complications, and visual acuity. The predictors of treatment failures were analyzed.
Results:
A total of 51 tumors regressed completely, and 20 incompletely. Out of 7 patients without response, 2 had enucleation, and 5 had Ru-106 irradiation. Recurrences after primary response were observed in 10 patients in 7-54 months (mean 23.4), 8 of them after incomplete regression. Six recurrences were successfully treated with additional TTT, and 4 with brachytherapy. There were no metastases or deaths. Logistic regression showed the main predictive factors for TTT failure to be tumor height (OR=6.85; 95% CI=1.2-38.1; p=0.02), basal diameter (OR=22.85; 95% CI=3.6-144.7; p=0.0003), amelanotic pigmentation (for primary failure, OR=9.18; 95% CI=1.7-49.2; p=0.008), high maximum systolic velocity (for primary failure, OR=13.6; 95% CI=2.3-81.7; p=0.003), subretinal fluid (OR=11.04; 95% CI=1.2-100.4; p=0.03), and incomplete regression (OR=30.62; 95% CI=6.0-156.4; p=0.00001). Receiver operating characteristic analysis showed the following cutoff levels: for tumor height 3.0 mm, for basal diameter 10.2 mm, for maximum systolic velocity 11.7 cm/s. Kaplan-Meier analysis of negative results was fulfilled in all treated patients and in patients without negative predictors. Mean visual acuity before TTT was 0.65, and after treatment 0.58. A total of 23% of patients had increased visual acuity, 42% had decreased acuity, and there was no change in 35%.
Conclusions:
TTT is an investigative treatment for choroidal melanomas. TTT needs careful selection of patients, based on consideration of predictive factors and functional perspectives.
