ANALYSIS OF METASTASIS-FREE SURVIVAL IN PATIENTS WITH SMALL CHOROID MELANOMA DEPENDING ON THE TYPE OF PRIMARY TUMOR TREATMENT

Background. There is no unified approach to the management of patients with small choroid melanoma (CM) (thickness up to 3 mm, base diameter up to 10 mm). The study of the development of metastases in these patients is of great significance for choosing an appropriate treatment method.Purpose: to assess the incidence of metastatic disease in patients with small CM, who were treated with transpupillary thermotherapy (TTT), photodynamic therapy (PDT), and brachytherapy (BT).Material and Methods. The retrospective study included 149 patients with CM, who were treated at the National Cancer Center of Belarus from 2005 to 2018. All patients had tumors less than 10 mm in diameter, less than 3 mm in thickness, and had no signs of systemic progression before starting therapy. All tumors corresponded to stage T1N0M0 (American Joint Committee on Cancer (AJCC)). 44 patients were treated with PDT, 47 with TTT, and 58 with BT.Results. The median follow-up time was 154 months (12 years) in patients treated with brachytherapy, 128 months (10 years) in patients treated with TTT and 72 months (6 years) in patients treated with PDT. During the follow-up period, metastases were observed in 1 (2.3 %) patient after PDT and in 5 (10.6 %) patients after TTT. In patients treated with BT, systemic progression was not recorded during the follow-up period. All cases of metastatic disease were associated with local recurrence or continued growth of CM.Discussion. The 5-year metastasis-free survival after TTT was worse than after PDT (82 ± 8.0 % and 94 ± 6.0 %, respectively, p<0.0001). However, in some cases, preference can be given to laser treatment methods, allowing the patients to avoid post-radiation retinopathies. The lack of local control of the tumor can be considered a surrogate marker for the development of metastatic disease. Conclusion. The highest metastasis-free rates were observed after brachytherapy. Positron emission tomography is recommended for early detection of systemic progression of the disease. Key words: choroid melanoma, uveal melanoma, transpupillary thermotherapy, photodynamic therapy, brachytherapy, metastatic-free survival, organ-preserving treatment.>˂0.0001). However, in some cases, preference can be given to laser treatment methods, allowing the patients to avoid post-radiation retinopathies. The lack of local control of the tumor can be considered a surrogate marker for the development of metastatic disease.Conclusion. The highest metastasis-free rates were observed after brachytherapy. Positron emission tomography is recommended for early detection of systemic progression of the disease.

Transpupillary laser thermotherapy of retinoblastoma

Introduction. Despite the fact that transpupillary thermotherapy (TTT) is one of the main local methods of small retinoblastoma (RB) destruction, only a few studies have been published on the use of this method, and they are devoted only to certain aspects of the application of TTT.Purpose of the study – to evaluate the effectiveness of TTT in the treatment of children with RB.Material and methods. In the period from 2011 to 2020, 177 children (224 eyes, 1156 tumors) with RB were treated by TTT. Of these, 99 (56 %) patients were boys, 78 (44 %) – girls. The mean age at the time of treatment was 16.8 months (from 0 to 86 months). Bilateral RB was observed in 128 (72.3 %) patients, monolateral – in 49 (27.7 %). In 51 (28.8 %) cases, TTT was performed on an only eye. TTT was performed on eyes that had RB of groups A (n = 43; 19 %), B (n = 81; 36 %), C (n = 31; 14 %), D (n = 63; 28 %), E (n = 6; 3 %). In total, 1156 tumors were treated by TTT. 488 (42 %) tumors were localized post-equatorially (of which 27 were located juxtapapillary, 23 – in the macular zone, 22 – paramacular). 668 (58 %) foci had pre-equatorial localization (on the middle and far periphery of the fundus). The number of foci in one eye varied from 1 to 48 (mean – 5). The mean tumor thickness was 1.1 mm (from 0.2 to 4.5), the mean base diameter was 2.2 mm (from 0.3 to 13.4). TTT was performed using a diode laser with the following parameters: wavelength – 810 nm, spot diameter – 1200 microns, power from 200 to 800 mW (mean – 350 mW), exposure-from 3 to 15 s in the application mode, and continuous in the scanning mode.Results. Complete tumor regression after TTT was achieved in 92 % of cases (1064 tumors). Incomplete regression of the tumor with stabilization was achieved in 0.7 % (8 tumors). The average number of TTT sessions to achieve full regression was 1.7 (from 1 to 10). Complete tumor regression after 1 TTT session was achieved in 54 % of cases (622 tumors), after 2 sessions – in 11 % (132 tumors), after 3 sessions – in 7 % (85 tumors), after 4 or more sessions– in 19 % (225 tumors). In 7 % of cases (82 tumors), due to the progression of the tumor, other treatment methods (brachytherapy, cryotherapy, stereotactic radiosurgery) were applied. 209 (93 %) eyes were preserved. 15 (7 %) eyes were enucleated due to continued tumor growth, total retinal detachment, vitreous hemorrhage, or subatrophy of the eyeball. The mean follow-up after TTT was 35.5 months (from 3 to 112 months).Conclusion. TTT is a highly effective method of RB treatment and can be used for destruction of small primary foci of both post-equatorial and pre-equatorial localization, residual tumors after inefficiency of other local methods. TTT is also effective in the treatment of large cavitary tumors located in functionally significant areas of the retina.

Transpupillary laser thermotherapy for retinoblastoma

The review article presents the literature data concerning the history of the use of thermotherapy in the treatment of intraocular tumors, in particular, retinoblastoma (Rb). The article describes the historical aspects of the use of transpupillary thermotherapy (TTT) and the possibility of using this method in the treatment of RB nowadays. The analysis of Russian and foreign publications on the main parameters of laser radiation and the multiplicity of TTT was carried out. The efficacy of TTT as an independent method of Rb treatment has been demonstrated. The frequency of the main complications of TTT in Rb is presented. Key words: ophthalmology, retinoblastoma, transpupillary thermotherapy, laser treatment, pediatric oncology.

Some aspects of diagnosis and treatment of a сircumscribed form of choroidal hemangioma complicated by macular edema

Introduction. The interest are rare cases of a сircumscribed choroidal hemangioma located juxtapapillary (JP) on the nasal side of the optic nerve disc (OND) and complicated by macular edema. Purpose. Studying the possibility of timely diagnosis and evaluating the effectiveness of treatment of a сircumscribed choroidal hemangioma complicated by macular edema. Material and methods. A retrospective analysis of the diagnostics and treatment results of 5 patients (5 eyes) with JP сircumscribed choroidal hemangioma, localized on the nasal side of the optic disc, complicated by macular edema, was carried out. Results. As a result, in all patients, already 1 month after the session of selective laser transpupillary thermotherapy (TTT), an increase in visual acuity and quality was observed, which was accompanied by pronounced resorption of intraretinal cysts and / or subretinal fluid in the macula. Conclusion. The purposeful use of modern diagnostic methods and the use of a sparing method of laser TTT makes it possible to identify and cure patients with CPCH complicated by macular edema without loss of visual functions. Key words: сircumscribed choroidal hemangioma, selective transpupillary thermotherapy, cystic macular edema.

Successful Treatment of Late Isolated Bone Metastasis in a Patient with Bilateral Retinoblastoma Using an Unconventional Method

Though survival in bilateral retinoblastoma (RB) has improved due to advancement in diagnostics and treatment modalities, children require long-term follow-ups for recurrence and second malignancies. We report a case of bilateral RB in a 7-month-old baby who was treated with chemotherapy, transpupillary thermotherapy, and periocular carboplatin for both eyes following which there was complete regression of tumour. Six and a half years after treatment, the child presented with metastatic recurrence of tumour in the left ulna. He was treated successfully with chemotherapy, extracorporeal radiation and reimplantation therapy. A less aggressive treatment approach for isolated bone relapse may be considered in selected cases.

Optical Coherence Tomography — Angiography in Revealing Predictors of Small Choroidal Melanoma Transpupillary Thermotherapy Efficiency

Purpose. To reveal predictors of small choroidal melanoma transpupillary thermotherapy efficiency using optical coherence tomography-angiography.Patients and methods. 34 patients with small choroidal melanoma at an average age of 55.0 ± 2.9 years were examined. Optical coherence tomography-angiography was performed on an OCT-Angiography Software for RS-3000 Advance Optical Coherent Tomograph, Nidek, Japan, before and 4 months after 1 session of transpupillary thermotherapy. Transpupillary thermotherapy (TTT) was performed with a Nidec DC 3300 diode laser.Results. Prior to TTT — a loop-shaped, cranked-convoluted with an uneven lumen heterogeneous nature of the vasculature of the tumor with numerous bends and interlacing, located under the vessels of the retina in the central zone; the area of neovascular vasculature is 32.82 mm2, the density is 12.42 %. The limiting avascular zone is on the periphery. Around melanoma is a homogeneous hyperreflective rim of dilated choriocapillaries. 4 months after 1 session of TTT in 24 (70.6 %) of 34 cases — occlusion of the choriocapillaries in the central and peripheral zone of the tumor (avascular regions), expansion of the large and medium vessels of the choroid around the focus — predictors of complete tumor devitalization (chorioretinal scar). In 6 (17.6 %) of 34 patients, occlusion of the choriocapillaries in the central zone, expansion of large and medium vessels of the choroid around the tumor, along its periphery and in the paracentral region, retinochoroidal anastamoses along the periphery and in the paracentral zone, heterogeneous neovascularization of the choriocapillaries around; decrease in the area of vasculature — 12.44 mm2, density — 6.15 %, (p < 0.05) — predictors of partial devitalization of small choroidal melanoma (residual tumor). In 4 (11.8 %) of 34 cases, tumor vessels in the tumor area, large and medium vessels of the choroid around, along its periphery and in the central zone, occlusion of the choriocapillaries in the central zone, retinochoroidal anastamoses in the periphery and in the central zone, heterogeneous neovascularization choriocapillaries around; vascular network area — 29.13 mm2, density — 10.17 %, (p > 0.05), lack of devitalization (continued growth).Conclusion. The introduction of optical coherence tomography-angiography revealed the predictors of the effectiveness of transpupillary thermotherapy of the initial melanoma of the choroid, which are various types of tumor vascularization, indicating its about complete, partial or absence devitalization after treatment.

Transpupillary thermotherapy of choroidal melanoma

A retrospective analysis of the immediate and long-term effectiveness of the treatment of the choroidal melanoma using transpupillary thermotherapy (TTT) was carried out. The study included 84 patients with choroidal melanoma (C69.3) who received treatment between 2007 and 2018. Patients were sampled from the Belarusian Cancer Register. The average values of the thickness of the tumor were 2.6±1.3 mm, the diameter of the base - 7.2±3.3 mm. TTT was carried out using a diode laser with a wavelength of 860 nm and radiation power of 200 - 800 mW, the exposure time was 60 s, and the diameter of the laser spot was varied between 1 and 3 mm. The entire surface of the tumor was thermally treated with overlapping fields from the periphery to the top. 75 patients underwent a single session of TTT, while 9 - two sessions with an interval of 3–4 weeks. As a result of the treatment, 51 (60.7%) patients showed complete tumor resorption, 28 (33.3%) patients had stabilization of the tumor process, and 5 (6.0%) patients had no effect. In the group of patients with stabilization of the tumor process, continued growth was recorded in 16 (19.1%) patients with follow-up periods of 3 months to 4 years. In 19 (37.3%) patients from the group with complete tumor regression, relapse was observed 1 to 8 years after TTT. Metastatic disease (disease progression) developed in 5 (5.9%) patients, of which in 1 patient during the first 12 months, in 1 patient - after 4 years, and in 3 patients more than after 5 years of the follow-up observation. Analysis of the effectiveness of TTT of choroidal melanoma showed that an increase in the thickness and diameter of the base of the tumor focus results in the decrease of immediate effectiveness, and the rise of the likelihood of continued tumor growth.