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Visual acuity after Gamma-Knife radiosurgery of choroidal melanomas
  1. Werner Wackernagel1,
  2. Etienne Holl2,
  3. Lisa Tarmann1,
  4. Alexander Avian3,
  5. Mona Regina Schneider1,
  6. Karin Kapp4,
  7. Gerald Langmann1
  1. 1Department of Ophthalmology, Medical University Graz, Graz, Austria
  2. 2Department of Neurosurgery, Medical University Graz, Graz, Austria
  3. 3Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
  4. 4Department of Therapeutic Radiology and Oncology, Medical University Graz, Graz, Austria
  1. Correspondence to Dr Werner Wackernagel, Department of Ophthalmology, Medical University Graz, Auenbruggerplatz, Graz 4A-8036, Austria; werner.wackernagel{at}medunigraz.at

Abstract

Background/aims To report on conservation of visual acuity after Gamma Knife radiosurgery of choroidal melanoma.

Methods A total of 189 patients with choroidal melanoma were treated with Gamma Knife stereotactic single-fraction radiosurgery at a single institution between June 1992 and May 2010. The main outcome measure of our retrospective analysis was conservation of pretreatment visual acuity of 20/40 or better, 20/200 or better and counting fingers (CF) or better, over time of follow-up. Patient, tumour and treatment parameters were evaluated as potential risk factors for visual loss.

Results Five years after treatment, the actuarial probability of keeping visual acuity better than 20/40, 20/200 and CF was 13%, 14% and 36%, respectively. The majority of patients (84.7%) encountered a deterioration of vision after treatment. The most important risk factors for visual loss were tumour height, longest basal diameter, distance to the optic disk and/or foveola, and retinal detachment before treatment. Treatment dose, and patient characteristics (age, sex, concurrent systemic diseases) were less important. Local tumour control rate was 94.4% after a median follow-up of 39.5 months.

Conclusions Visual outcome after single-fraction Gamma Knife radiotherapy is comparable with linear accelerator (LINAC) based fractionated stereotactic radiotherapy, inferior to proton beam radiotherapy, and depends primarily on tumour size, location and pre-existing retinal detachment.

  • Neoplasia
  • Choroid
  • Treatment other
  • Vision

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