Transpupillary Thermotherapy

Abstract

To evaluate the efficacy and safety of transpupillary thermotherapy in treating choroidal melanoma. Methods and Patients: To perform transpupillary thermotherapy, infrared diode laser energy at 810 nm was used with a beam diameter of about 3 mm and 1-minute exposure time. All 50 patients had choroidal melanoma. We performed transpupillary thermotherapy in 21 tumors that had responded insufficiently to 800 Gy ruthenium 106 brachytherapy; it was combined with 800 Gy 106 Ru brachytherapy for 10 tumors greater than 5 mm in height and with 600 Gy for 19 tumors 5 mm or less in height. Results: Allbut1tumorexhibitedreductionintumorheight within a mean follow-up of 20.5 months (range, 6-49 months). In 41 eyes (82%), the tumor flattened completely. Visual acuity was 20/60 or better in 43 eyes (86%) before treatment and in 14 eyes (28%) at the last examination because of radiation vasculopathy. Neovascular glaucoma developed in 1 eye, and total retinal detachment developed in 2 eyes. Tumor recurrence was observed in 1 patient. Conclusions: Although long-term results are necessary to properly appraise this new therapy, transpupillary thermotherapy may be useful as a complementary modality to brachytherapy.

Current and emerging treatment options for uveal melanoma

“…Tumor necrosis is induced by direct cell destruction. Although originally developed as an adjunct to plaque brachytherapy (BT),25 interest in TTT as a primary therapy grew based on the assumption that it may provide improved visual outcomes as compared with plaque radiotherapy. However, longer follow-up of initial studies using TTT as primary treatment for small posterior tumors revealed a high risk of local recurrence: 10% at 3 years, increasing to 33% at 10 years 26–28.…”

“…Thus, current evidence limits TTT to use as an adjunct to plaque BT. Several studies of combined TTT and BT have been published to date;25,30,31 however, they consist of varying treatment regimes with regard to the timing of TTT and the use of various isotopes. Most recently, the largest retrospective comparative study to date of 133 patients treated either with BT + TTT (n = 63) or with BT alone (n = 70) revealed there to be significant benefits from simultaneous TTT + BT.…”

Thermooptical comparison of different approaches and lasers for laser treatment of intraocular tumors

“…Similarly, small choroidal melanomas may be treated with argon or krypton laser photocoagulation. There are some publications concerning the application of diode laser radiation with wavelength 0.810 µm for treatment of intraocular tumors [3][4][5]. Unfortunately there are many cases of failure, of unwanted adverse effects and the application of the lasers for tumor treatment is often limited by these ones.…”

Was kann die Transpupilläre Thermotherapie (TTT) in der Behandlung von flachen posterioren Aderhautmelanomen leisten? - Eine systematische Literaturübersicht

“…Oosterhuis u. Mitarb. haben flber eine Serie von insgesamt 50 mit TTT behandelten Patienten berichtet [13]. Eine Gruppe wurde wegen unzureichender Tumorregression nach Brachytherapie (Ru106) nachbehandeit.…”