9060 Background: Uveal melanoma is a rare cancer, it represents 5% to 6% of all melanoma diagnoses (annual incidence approximately 0.5-0.7:100000). Up to 50% of patients with UM will develop metastatic disease within 15 years from the treatment of primary tumor. The preferred spread is hematogenous and the liver is the first or prevalent site of metastatic disease in up to 95% of the recurring patients. The median survival time of metastatic uveal melanoma is generally poor, with reported median life expectancy from 3.6 to 15 months and no standard therapy established so far. Methods: We retrospectively reviewed our database of patients treated at Veneto Region Oncology Research Institute for metastatic uveal melanoma, grouped by liver replacement percentage, to evaluate the benefit of treatment with transarterial chemoembolization with CPT-11 charged microbeads combined with systemic fotemustine (f-TACE) in this set of patients. From 1990 to 2013, 156 patients were treated for metastatic uveal melanoma in our Centre. Among them, 147 patients had liver metastases and 127 had enough information recorded to perform the study and were analyzed. Results: Among 127 patients with liver metastases, 49 were treated with f-TACE as first line-therapy. The cohort of patients treated with f-TACE and the cohort that did not receive f-TACE were not significantly different for prognostic factors. The treatment with f-TACE conferred a survival advantage (20.6 vs 14.7 months, respectively; p=.050); the advantage was maintained when analysis was performed with stratification for liver metastatic substitution (HR= 0.58, p=.002). The treatment was not affected by severe toxicities. Conclusions: F-TACE seems a tolerable regimen that confers an improvement in survival of uveal melanoma patients with liver metastases. Our data prompt for the conduction of perspective comparative studies confirming the efficacy of f-TACE and, in the future, we advise combination treatments with targeted drugs.
To report long-term clinical outcome of topical 1% 5-fluoruracil (5-FU) as a sole treatment of ocular surface squamous neoplasia (OSSN).
Methods
41 patients affected by OSSN were included. Each patient underwent full ophthalmological examination at baseline, with cytological or histological confirmation. Patients were treated by topical chemotherapy with 1% 5-FU four times a day for 4 weeks. One course was defined as 4 weeks of topical chemotherapy. Adjunctive courses were administered after 1 month of chemotherapy-free interval.
Results
Mean follow-up was 105±32 months (range 60–171 months). Complete tumour regression was achieved in 34 cases (83%) after a mean of 1.5 courses (range, 1–3 courses). Univariate analysis revealed that complete response was significantly related to tumour thickness <1.5 mm (p=0.005), lack of fornix or tarsal involvement (p=0.015 and p=0.009, respectively) and the absence of multifocality (p=0.002). Histopathological diagnosis (intraepithelial neoplasia vs squamous cell carcinoma, p=0.019) and American Joint Committee on Cancer (AJCC) classification (T1 vs T2 or T3) (p=0.028) were also related to incomplete tumour response. In a multivariate analysis, just tumour thickness >1.5 mm (p=0.045) and multifocality (p=0.023) were correlated with incomplete tumour response. Transient and reversible low-to-mild local side effects were documented in 19 (48%) eyes.
Conclusion
Topical 5-FU, as a sole therapy, is a long-term safe and effective treatment for patients affected by preinvasive OSSN and for a limited proportion (50%) of invasive OSSN.
Purpose To evaluate safety and efficacy of photodynamic therapy (PDT) for the treatment of choroidal metastases. Methods Five cases of selected, symptomatic choroidal metastases were included in this prospective study. Each patient underwent a single-spot standard-fluence PDT with verteporfin (50 J/cm2, 83 sec.). BCVA, fundus photography and optical coherence tomography were performed at baseline and at each follow-up examination (at 1 month and every 3 months thereafter). Fluorescein angiography and indocyanine green angiography were performed at baseline. Results In two patients choroidal metastases were secondary to carcinoid tumors, in two cases to lung and in one case to breast adenocarcinoma. Mean follow-up was 17±6 months. Mean PDT sessions were 1.6 (1-3 sessions). Three patients (60%) showed clinical regression of the treated lesions and in two patients (40%) tumor size remained stable during follow-up. Subretinal fluid resolved in al cases. BCVA increased in four patients (80%) and remained unchanged in one patient (20%). Conclusion Photodynamic therapy appears as an effective and well-tolerated treatment option for the management of selected choroidal metastasis
Fundus autofluorescence is a noninvasive imaging modality detecting the lipofuscin and melanolipofuscin content at the retinal pigment epithelium level. This technique may reveal the effects of choroidal tumors on the overlying retinal pigment epithelium and may also provide specific information on intrinsic pigments that compose and characterize various chorioretinal lesions. Lipofuscin, melanin, and melanolipofuscin strongly influence the autofluorescence patterns of the chorioretinal tumors, but other pigments may theoretically influence the autofluorescence pattern of these lesions. In this chapter we review the role of autofluorescence in the diagnosis of benign and malignant chorioretinal lesions.
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