ИСТИНА

Currently a wide spectrum of eye-sparing treatment modalities for posterior uveal melanoma (PUM) are in use but they have limited indications. Purpose: to present the results of gamma-knife radiosurgery (GKRS) of PUM unsuitable for other eye-sparing treatment modalities. Methods: Since 2012 sixteen consecutive patients aged from 15 to 78 years with PUM were included into the study and treated with GKRS. These tumors were not indicated to other eye-sparing modalities available in our clinic – ruthenium-106 brachytherapy, transretinal excision, transscleral excision, or laser treatment, because of the size or/and location. Majority of patients refused to remove the eye. Two patients had the only eye. Tumor thickness was from 5.5 to 9.6 mm, mean 7.7 mm, basal diameter from 9.4 to 21.4 mm, mean 15.0 mm. Four tumors were juxtapapillar. GKRS irradiation doses were 35-40 Gy on 50% isodose curve. Results: Partial tumor regression was achieved in all cases. There were no cases of complete regression. Regression after GKRS was much slower than after brachytherapy. Two peripapillar tumors progressed and the eyes were enucleated. Two patients underwent endoresection of irradiated tumors 2 years after GKRS because of very limited response. One eye was removed because of phthisis bulbi. Vision increased in 3 patients, decreased in 5. One patient developed liver metastasis and died in 2 years after treatment. Thirteen eyes (81%) were preserved. The follow up was from 12 to 82 months, mean 39 months. Conclusion: GKRS is an effective treatment option for PUM not suitable for brachytherapy or surgical excision and can save the eye and vision in selective cases.