Transpupillary thermotherapy combined with 106Ru as a method of managing choroidal melanoma

BACKGROUND: A study was carried out to evaluate the effectiveness of transpupillary thermotherapy (TTT) with diode laser applied as adjuvant treatment to 106Ru brachytherapy in choroidal melanoma. These two methods coined as "sandwich therapy" are complementary and allow to decrease the dose of radiation. MATERIAL AND METHODS: Between November 1996 and December 1997, 45 patients with choroidal melanoma were treated simultaneously with 106Ru and TTT. There were 18 males and 27 females, aged 20 to 78 (mean 57). There were 7 tumors with height of 5 mm or less, 28 ranging 5.43-8.63 mm and 10 with height 9 mm or more. The anterior tumor margin was located in the equator area or posterior to it in 71.1% of cases. The laser treatment was delivered using spots 2-3 mm in size, at a mean power 600 mW, for about 1 minute. The mean radiation dose was 60 Gy to the tumor apex. The follow-up ranged from 12 to 24 months. RESULTS: Reduction in tumor height by at least 30% was exhibited in 35 (77.8%) tumors, in one evaluated as positive result it was 27%. There was no improvement after treatment in 4 cases, 2 eyes were enucleated. A significant relationship was found between tumor thickness and the result of treatment. CONCLUSION: Our preliminary observations suggest that TTT combined 106Ru brachytherapy is an effective method of treatment. A longer follow-up is needed to assess final local results and the impact of treatment on survival.