Treatment of choroidal melanoma;22 years of experience in Slovenia
Introduction. Uveal melanoma is the most common primary malignancy of the eye. The Cancer Registry of Slovenia reported the incidence of choroid melanoma from 1983 to 2009 as stable, at 7.8 cases/million for men and 7.4/million for women.
Patients and Methods. From 1986 to December 2008 we treated 288 patients with malignant melanoma of the choroid (MMC). 127 pts was treated by brachytherapy with beta rays emmiting ruthenium-106 applicators, 161 pts were treated by enucleation.
Results. Pts treated by brachytherapy had 5-and 10- years overall mortality 13% and 32% respectively. Pts treated by enucleation had 5- and 10 years mortality 46 % and 69% respectively. The difference could be atributed to selection of the pts with tumours larger than 7 mm in height and base larger than 16 mm to the treatment by enucleation.
30 pts treated by brachytherapy developed local reccurence. 25 of 127 pts treated by brachytherapy and 86 of 161 those treated by enucleation developed metastases. Patients of age ≥60years had significantly worse survival in both treatment modalities. For pts treated by brachytherapy the diameter of the tumour and time of implantation were independent prognostic factors for survival, for pts treated by enucleation only histological type of tumour was significant. In first years after treatment of the primary tumour there is a temporary increase in melanoma mortality rate especially in older patients.
Conclusions. It seems that some patients can be cured, particularly younger patients with early tumours, whereby preference is given to eyesight preserving brachytherapy over enucleation.