Microinvasive tumor endoresection in combination with ocular stereotactic radiosurgery

Area of Science:

• Ophthalmology
• Oncology
• Radiation Oncology

Background:

• Gamma Knife radiosurgery (GKRS) offers high local control for uveal melanoma (UM) but may not prevent enucleation for large tumors.
• Secondary enucleation is a risk in large UM cases treated with GKRS monotherapy, particularly due to glaucoma.
• Endoresection (ER) is explored as an adjunct to GKRS for specific UM presentations.

Purpose of the Study:

• To analyze indications, timing, and outcomes of endoresection (ER) for uveal melanoma (UM) following Gamma Knife radiosurgery (GKRS).
• To evaluate the efficacy of combined GKRS and ER in preserving the eye and vision for large UM.
• To assess complications and visual results of this combined treatment strategy.

Main Methods:

• Thirty-seven UM patients underwent GKRS (70-80 Gy).
• Twenty-one patients had ER performed 3-97 days post-GKRS, primarily for large, central, or equatorial UM with visual impairment.
• ER involved vitrectomy, tumor resection, laser, silicone oil tamponade; some received anti-VEGF injections.

Main Results:

• All 37 patients achieved eye preservation without tumor recurrence post-GKRS.
• In the ER group (21 eyes), 19% developed glaucoma, and 19% had radiation neuroretinopathy; anti-VEGF injections reduced edema.
• Useful vision (>0.1) was achieved in 57% of ER eyes, with 38% achieving >0.3.

Conclusions:

• Endoresection (ER) after Gamma Knife radiosurgery (GKRS) is an effective eye-conserving treatment for large uveal melanomas (UM).
• This combined approach successfully manages tumors at risk for toxic tumor syndrome, preserving ocular structures and useful vision.
• Optimal outcomes depend on precise immobilization, timely ER, anti-angiogenic therapy, and multidisciplinary collaboration.