Comparative analysis of primary endoresection and brachytherapy with Ru-106 in the treatment of «large» choroidal melanomas

    Abstract

    Original article

    Comparative analysis of primary endoresection and brachytherapy with Ru-106 in the treatment of «large» choroidal melanomas

    A.A. Yarovoy, I.M. Gorshkov, V.I. Miroshnikov, D.P. Volodin

    S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation

    Purpos. To conduct a comparative analysis of the local tumor control, local and systemic safety of primary endoresection (ER) of «large» choroidal melanoma (CM) compared to brachytherapy (BT) with Ru-106 in statistically homogeneous groups.

    Material and methods. A total of 35 patients (35 eyes) aged 30 to 75 years (mean — 58 years) with CM were treated with primary ER from 2014 to 2024. Among them, there were 9 (26%) women and 25 (74%) men. According to the international TNM classification (AJCC) (2017), 11 (31%) patients had tumors classified as stage T3, while 24 (69%) had stage T2. No metastases of CM were detected in any patient at the time of treatment. The tumor thickness before treatment ranged from 6.0 to 11.6 mm (mean — 8.2 mm), the largest basal diameter varied from 7.8 to 13.9 mm (mean — 11 mm). A comparative analysis of ER and BT was conducted in two independent groups, which were standardized by the main clinical characteristics: age at the time of treatment, preoperative best-corrected visual acuity, tumor thickness and basal diameter, tumor location, and the follow-up.

    Results. The comparative analysis of local tumor control did not reveal statistically significant difference (p=0.45). In the ER group, the surgical chorioretinal coloboma without tumor recurrence was observed in 33 patients (94%), tumor recurrence was identified in 2 cases (6%). In the BT group complete tumor regression was observed in 14% of cases, incomplete regression in 75%, and tumor progression in 11%. 23% of patients underwent adjuvant treatment after BT (either repeated BT or transpupillary thermotherapy). The comparative analysis of complication rates (cataract, retino-/maculopathy, neuropathy/partial optic nerve atrophy, retinal detachment, vitreous hemorrhage, secondary glaucoma) after primary ER and BT with Ru-106 did not demonstrate statistically significant difference: complications occurred in 62% of the ER group and in 59% - in the BT group (p=0.93). However, there was a trend towards a statistically significantly lower frequency of all complications except cataract after ER compared to BT (p=0.08).

    Conclusion. Thus, the comparative analysis in statistically homogeneous groups demonstrated that primary ER of CM is a highly effective approach for the treatment of «large» CM that is comparable to BT in local tumor control and does not increase the risk of enucleation or metastasis in comparable groups. The results suggest that primary ER for CM can be widely used in clinical practice for the treatment of «large» CM.

    Key words: uveal melanoma, primary endoresection, vitreoretinal surgery, choroidal melanoma, large tumors, brachytherapy with Ru-106

    For citation: Yarovoy A.A., Gorshkov I.M., Miroshnikov V.I., Volodin D.P. Comparative analysis of primary endoresection and brachytherapy with Ru-106 in the treatment of «large» choroidal melanomas. Fyodorov Journal of Ophthalmic Surgery. 2025;2s(145): 48–53.

    DOI: 10.25276/0235-4160-2025-2S-48-53

    Corresponding author: Vladimir I. Miroshnikov, vladimir.miroshnikov@icloud.com