The present paper reports on follow-up examinations of 246 patients after Ruthenium106 treatment of choroidal melanomas (follow-up time 1.8 to 13 years). In January 1988, 212 patients were alive and free of metastases; 15 had died, 12 of them of melanoma metastases, and 17 could not be followed up. In a retrospective analysis of factors influencing tumor-related mortality, the rate of regression of irradiated tumors was found to be particularly significant. The mean time taken to reduce tumor volume by half was 4.4 months in patients who died of metastases, as against 6.6 months in a matched group of survivors. Using discriminance analysis, the difference was found to be highly significant (P = 0.0058). In the total patient population, a significant correlation was found between pretreatment tumor volume and the probability of metastases (P = 0.058). It may be concluded, though with the qualification that the number of tumor-related deaths was small, that the tumor regression rate is an important factor in the prognosis for patients with Ruthenium-treated malignant choroidal melanomas.
The ultrasonographic findings in 39 cases of malignant melanoma of the choroid has been correlated with histopathological results. Tumors with hemorrhages and/or necrosis showed a lower reflectivity than those with a higher amount of connection tissue. B-scan ultrasonography was found to be reliable for the measurement of the extent of the tumor in all three dimensions.
In 75% of the patients with malignant melanoma of the choroid useful vision can be retained by beta-radiation with ruthenium-106/rhodium. Tumors with a prominence of more than 6 mm should be treated only for very special reasons. There is a statistically proven correlation between the initial tumor volume and the occurrence of residual tissue volume. Histopathological investigations have shown that residuals of the tumor do not permit any conclusions concerning the dignity or vitality of tumor cells. The risk to life is not increased by the conservative procedure, and it may even be reduced.
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