Czech and Slovak Ophthalmology 146 10.31348/2020/6 Original article Enucleation After Stereotactic Radiosurgery in Patients With Uveal Melanoma Zahorjanová Pavlína Sekáč Ján Babál Pavel Štubňa Michal 30 8 2020 1 6

Introduction: In the past enucleation was the treatment of choice for all the patients with uveal melanoma. Nowadays, we prefer glope-sparing treatment modalities, except for large tumors, tumors with extrascleral extension and painful blind eyes. Most of the patients perform radiotherapy or local resection techniques. In Slovak Republic, the only one possibility is a stereotactic radiotherapy on a linear accelerator LINAC. Nevertheless, enucleation after radiotherapy is necessary for some patients. The causes are postradiation complications, mainly neovascular glaucoma, tumor recurrence, tumor progression or patient´s decision. Material and methods: The retrospective non-randomised study of 168 eyes of the patients with choroidal or ciliary body melanoma, who performed one-day session stereotactic radiosurgery at the linear accelerator LINAC during period 2007-2016. The data about postradiation complications were analysed based on the medical records of the patients and the data about enucleated eyes based on the histopathological findings. Results: The occurence of enucleation after radiotherapy in our cohort was 17 % (28 patients), with median time period after radiotherapy 21,5 months. The most common cause was neovascular glaucoma (82 %), then tumor progression (14 %) and patient´s decision (4 %). The most common histopathological finding was spindle-cell melanoma. Discussion: Others authors describe similar enucleation rate and causes. The histopathological findings indentified more viable melanoma cells in eyes enucleated for tumor progression in comparison with enucleation for other causes. Enucleation may be more difficult and the occurence of postoperative complications can be higher in the eyes after radiotherapy rather than primary enucleation. Conclusion: The management of the patients with uveal melanoma is difficult, and requires the cooperation of ophthalmologist, oncologist, radiation physicist and pathologist. Even if we make effort to preserve the eye, enucleation after radiotherapy is necessary in some patients.

 uveal melanoma enucleation histopathological findings References Damato, B., Singh, A.D: Clinical Ophthalmic Oncology: Uveal Tumors. Berlin, Springer, 2014, 382 p. Fabian, I.D., Tomkins-Netzer, O., Stoker, I., et al: Secondary Enucleations for Uveal Melanoma: A 7-Year Retrospective Analysis. Am J Ophthalmol, 160(6); 2015: 1104-1110. Furdová, A., Babál, P.: Giant Orbital Melanoma in a Heroin Abuser. Case Rep Ophthalmol, 8(1); 2017: 288-293. Furdová, A., Babál, P., Kobzová, D., et al.: Uveal melanoma suvrival rates after single dose stereotactic radiosurgery, 65(6); 2018: 965-971. Furdová, A., Horkovičová, K., Justusová, P., et al.: Is it sufficient to repeat linear accelerator stereotactic radiosurgery in choroidal melanoma? Bratisl Lek Listy, 117(8); 2016: 456-462. Furdová, A., Oláh, Z.: Nádory oka a okolitých štruktúr. Akademické nakladatelství CERM, 2010, 152 s. Furdová, A., Růžička, J., Šramka, M., et al.: Choroidal melanoma stage T1 – comparison of the planning protocol for stereotactic radiosurgery and proton beam irradiation. Cesk Slov Oftalmol, 68(4); 2012, 156-161. Furdová, A., Slezák, P., Chorváth, M., et al.: No differences in outcome between radical surgical treatment (enucleation) and stereotactic radiosurgery in patients with posterior uveal melanoma. Neoplasma, 57(4); 2010: 377-381. Furdová, A., Strmeň, P., Šramka, M.: Complications in patients with uveal melanoma after stereotactic radiosurgery and brachytherapy. Bratisl Lek Listy, 106(12); 2005: 401-406. Furdová, A., Strmeň, P., Waczulíková, I., et al.: One-day session LINAC-based radiosurgery of posterior uveal melanoma. European Journal of Ophthalmology, 22(2); 2012: 226-235. Furdová, A., Šramka, M.: Uveal malignant melanoma and stere - otactic radiosurgery. Saarbrucken, LAP LAMBERT Academic Publishing, 2014, 181 s. Furdová, A., Šramka, M., Chorváth, M., et al.: Clinical experience of stereotactic radiosurgery at a linear accelerator for intraocular melanoma. Melanoma Res, 27(5); 2017: 463-468. Furdová, A., Šramka, M., Chorváth, M., et al.: Stereotactic radio - surgery in intraocular malignant melanoma – retrospective study. Neuro Endocrinol Lett, 35(1); 2014: 28-36. Furdová, A., Waczulíková, I., Šramka, M., et al.: Relative survival rates and presence of complications in uveal melanoma patients after stereotactic radiosurgery. Adv Ophthalmol Vis Syst, 8(6); 2018: 283-289. Group TCOMS: The Collaborative Ocular Melanoma Study (COMS) randomized trial of large choroidal melanoma: IV. Ten-year mortality findings and prognostic factors. COMS report number 24. Am J Ophthalmol, 138(6); 2004: 936-51. Chen, X., Maniotis, A.J., Majumdar, D., et al.: Uveal melanoma cell staining for CD34 and assessment of tumor vascularity. Invest Ophthalmol Vis Sci, 43(8); 2002: 2533-9. Justusová, P., Štubňa, M., Veselovský, M., et al.: Exenterácia orbity u pacienta s generalizovaným choroidálnym melanómom. Cesk Slov Oftalmol, 72(3); 2016: 92-96. Kilic, E., Stijnen, T., de Jong, P.T., et al.: Reduced melanoma-related mortality in uveal melanoma by preenucleation radiotherapy. Arch Ophthalmol, 123(10); 2005: 1363-7. Krantz, B.A., Dave, N., Komatsubara, K.M., et al.: Uveal melano - ma: epidemiology, etiology and treatment of primary disease. Clin Ophthalmol. 2017;11:279-289. Mäkitie, T., Summanen, P., Tarkkanen, A., et al.: Tumor-infiltrating macrophages (CD68+ cells) and prognosis in malignant uveal melanoma. Invest Ophthalmol Vis Sci, 42(7); 2001: 1414-21. Pham, C.M., Custer, P.L., Couch, S.M.: Comparison of primary and secondary enucleation for uveal melanoma. Orbit, 36(6); 2017: 422-7. Seregard, S., Lundell, G., Lax, I., et al.: Tumour cell proliferation after failded ruthenium plaque radiotherapy for posterior uveal melanoma. Acta Ophthalmol Scand, 75; 1995: 148-154. Sekáč, J., Ferková, S.L., Kollárová, A., et al.: Secondary glaucoma in small versus large uveal melanoma patients treated with stereotactic radiosurgery on linear accelerator. Bratisl Med J, 120(12); 2019: 945-949. Singh, A.D., Kalyani, P., Topham, A.: Estimating the risk of malignant transformation of a choroidal nevus. Ophthalmology, 112(10); 2005: 1784-9. Smolková, B., Horváthová Kajabová, V., Zmetáková, I., et al.: Role of epigenetic deregulation in hematogenous dissemination of malignant uveal melanoma. Neoplasma, 65(6); 2018: 840-854. Zahorjanová, P., Furdová, A., Waczulíková, I., et al.: Postradiačná ma - kulopatia u pacientov s malígnym melanómom corpus ciliare a chorioidey po stereotaktickej rádiochirurgii. Cesk Slov Oftalmol, 75(1); 2019: 3-10.