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March 1995

Transpupillary Thermotherapy in Choroidal Melanomas

Author Affiliations

From the Department of Ophthalmology, Leiden (the Netherlands) University Medical Center.

Arch Ophthalmol. 1995;113(3):315-321. doi:10.1001/archopht.1995.01100030071024

Objective:  To determine safety and efficacy of transpupillary thermotherapy (TTT) as a new treatment for choroidal melanoma.

Methods and Patients:  To perform TTT, diode laser energy at 810 nm was used with a beam diameter of 1.5 to 4.5 mm for a 1-minute exposure. All 12 patients had choroidal melanoma. Six had had insufficient response to ruthenium 106 (106Ru) brachytherapy. Three patients with tumors more than 5 mm in height were treated simultaneously with 106Ru and TTT. Three patients with juxtapapillary or macular tumors were treated by TTT only.

Results:  All but one tumor exhibited a reduction of tumor height in a follow-up period of 3 to 14 months. Side effects were minimal. Severe visual loss occurred in two patients due to radiation retinopathy, in two patients whose foveas were included in the TTT area, and in one patient resulting from a serous retinal detachment that extended over the posterior pole.

Conclusions:  Treatment with TTT may be useful as a complementary modality to brachytherapy. A longer follow-up period is required for final evaluation.

Haik BG, Jereb EB, Abramson DH, Ellsworth RM.  Ophthalmic radiotherapy . In: Iliff N, ed. Complications in Ophthalmic Therapy . New York, NY: Churchill Livingstone Inc; 1983:449-485.
Lommatzsch PK, Kirsch IH.  106Ru/106Rh plaque radiotherapy for malignant melanomas of the choroid . Doc Ophthalmol . 1988;68:225-238.Article
Hall EJ, Roizin-Towie L.  Biological effects of heat . Cancer Res . 1984;44( (suppl) ): 4708s-4713s.
Leeper D.  Molecular and cellular mechanism of hyperthermia alone or combined with other modalities . In: Overgaard J, ed. Hyperthermic Oncology . London, England: Taylor & Francis Ltd; 1985;2:9-40.
Reese AB, Archila EA, Jones IS, Cooper WC.  Necrosis of malignant melanoma of the choroid . Am J Ophthalmol . 1970;69:91-104.
Samuels B.  Anatomic and clinical manifestations of necrosis in 84 cases of choroidal sarcoma . Arch Ophthalmol . 1934;11:988-1027.
Kim JH, Hahn EW, Tokita N.  Combination hyperthermia and radiation therapy for cutaneous malignant melanoma . Cancer . 1978;41:2143-2148.Article
Overgaard J, Overgaard M.  Hyperthermia as an adjuvant to radiotherapy in the treatment of malignant melanoma . Int J Hyperthermia . 1987;3:483-501.Article
Emami B, Perez CA, Konefal J, et al.  Thermoradiotherapy of malignant melanoma . Int J Hyperthermia . 1988;4:373-381.Article
Lagendijk JJW.  Microwave applicator for hyperthermic treatment of retinoblastoma . Natl Cancer Inst Monogr . 1982;61:469-471.
Riedel KG.  Hypertherme Therapieverfahren in Ergänzung zur Strahlenbehandlung maligner intraokularer Tumoren . Klin Monatsbl Augenheilkd . 1988;193:131-137.Article
Swift PS, Stauffer PR, Fries PD, et al.  Microwave hyperthermia for choroidal melanoma in rabbits . Ophthalmol Vis Sci . 1990;31:1754-1760.
Finger PT.  Microwave plaque thermoradiotherapy for choroidal melanoma . Br J Ophthalmol . 1992;76:358-364.Article
Liggett PE, Pince KJ, Astrahan M, Rao N, Petrovich Z.  Localized current field hyperthermia: effect on normal ocular tissue . Int J Hyperthermia . 1990;6:517-527.Article
Petrovich Z, Astrahan MA, Luxton G, Green R, Langholz B, Liggett PE.  Episcleral plaque thermoradiotherapy in patients with choroidal melanoma . Int J Radiat Oncol Biol Phys . 1992;23:599-603.Article
Coleman DJ, Lizzi FL, Burgess SEP, et al.  Ultrasonic hyperthermia and radiation in the management of intraocular malignant melanoma . Am J Ophthalmol . 1986;101:635-642.
Coleman DJ, Silverman RH, Iwamoto T, et al.  Histopathologic effects of ultrasonically induced hyperthermia in intraocular malignant melanoma . Ophthalmology . 1988;95:970-981.Article
Braakman R, van der Valk P, van Delft JL, de Wolff-Rouendaal D, Oosterhuis JA.  The effects of ultrasonically induced hyperthermia on experimental tumors in the rabbit eye . Invest Ophthalmol Vis Sci . 1989;30:835-844.
Mieler WF, Jaffe GJ, Steeves RA.  Ferromagnetic hyperthermia and iodine 125 brachytherapy in the treatment of choroidal melanoma in a rabbit model . Arch Ophthalmol . 1989;107:1524-1528.Article
Journée-de Xorver JG, Verburg-van der Marel EH, Oosterhuis JA, van Best JA, de Wolff-Rouendaal D.  Tumoricidal effect of hyperthermia by near infrared irradiation on pigmented hamster melanoma . Lasers Light Ophthalmol . 1992;4:175-180.
Geeraets WJ, Berry ER.  Ocular spectral characteristics as related to hazards from lasers and other light sources . Am J Ophthalmol . 1968;66:15-20.
Journée-de Korver JG, Oosterhuis JA, Kakebeeke-Kemme HM, de Wolff-Rouendaal D.  Transpupillary thermotherapy (TTT) by infrared irradiation of choroidal melanoma . Doc Ophthalmol . 1992;82:185-191.Article
Meyer-Schwickerath G.  Further progress in the field of light coagulation . Trans Ophthalmol Soc U K . 1957;77:421-440.
Meyer-Schwickerath G, Bornfeld N.  Photocoagulation of choroidal melanomas: thirty years experience . In: Lommatzsch PK, Blodi FC, eds. Intraocular Tumors . Berlin, Germany: Akademie-Verlag; 1983:269-276.
François J.  Treatment of malignant choroidal melanomas by photocoagulation . Ophthalmologica . 1982;184:121-130.Article
Meyer-Schwickerath G.  Photocoagulation of choroidal melanomas . Doc Ophthalmol . 1980;50:57-61.Article
De Laey JJ, Hanssens M. Ryckaert S.  Photocoagulation of malignant melanomas of the choroid: a reappraisal . Bull Soc Beige Ophtalmol . 1986;213:9-18.
Klaus H, Lommatzsch PK, Fuchs U.  Histopathology studies in human malignant melanomas of the choroid after unsuccessful treatment with 106Ru/106Rh ophthalmic applicators . Graefes Arch Clin Exp Ophthalmol . 1991;229:480-486.Article
Boniuk M, Cohen JS.  Combined use of radiation plaques and photocoagulation in the treatment of choroidal melanomas . In: Jakobiec FA, ed. Ocular and Adnexal Tumors . Birmingham, Ala: Aesculapius Publishers Inc; 1978:80-85.
Zygulska-Mach H, Maciejewski Z, Link E.  Conservative treatment of choroidal melanomas; combined use of cobalt plaques and photocoagulation . In: Lommatzsch PK, Blodi FC, eds. Intraocular Tumors . Berlin, Germany: AkademieVerlag; 1983:417-423.
Moura RA, McPherson AR, Easley J.  Malignant melanoma of the choroid: treatment with episcleral 198Au plaque and xenon-arc photocoagulation . Ann Ophthalmol . 1985;17:114-125.
Lee KY, Sabates FN, Ziemanski MC, et al.  Combined iodine-125 plaque irradiation and laser photocoagulation in the treatment of choroidal malignant melanoma . In: Bornfeld N, Gragoudas ES, Höpping W, Lommatzsch PK, Wessing A, Zografos L, eds. Tumors of the Eye . Amsterdam, the Netherlands: Kugler; 1991:441-447.
Foulds WS, Damato BE.  Low energy long-exposure laser therapy in the management of choroidal melanoma . Graefes Arch Clin Exp Ophthalmol . 1986;224:26-31.Article
Augsburger JJ, Kleineidam M, Mullen D.  Combined iodine-125 plaque irradiation and indirect ophthalmoscope laser therapy of choroidal malignant melanomas: comparison with iodine-125 and cobalt-60 plaque therapy alone . Graefes Arch Clin Exp Ophthalmol . 1993;231:500-507.Article
Goldbaum MH.  Long-wavelength long-exposure therapy of choroidal melanoma . In: Gitter K, McDonald RH, eds. Laser Photocoagulation of Retinal Disease . San Francisco, Calif: Pacific Medical Press; 1988:261-267.
Chong LP, Özler SA, De Queiroz JM, Liggett PE.  Indocyanine green-enhanced diode laser treatment of melanoma in a rabbit model . Retina . 1993;13:251-259.Article
Meyer-Schwickerath G. Lichtkoagulation: Bucherei des Augenarztes 35 . Stuttgart, Germany: Ferdinand Enke Verlag; 1959.
Svaasand LO, Ellingsen R.  Optical penetration in human intracranial tumors . Photochem Photobiol . 1985;41:73-76.Article
Svaasand O, Boerslid T, Oeveraasen M.  Thermal and optical properties of living tissue: application to laser-induced hyperthermia . Lasers Surg Med . 1985;5:589-602.Article
L'Esperance FA.  Technical considerations for ocular photocoagulation . In: Klein E, ed. Ophthalmic Lasers . St Louis, Mo: CV Mosby Co; 1989:78-113.
Patterson MS, Wilson BC, Wyman DR.  The propagation of optical radiation in tissue, II: optical properties of tissues and resulting fluence distributions . Lasers Med Sci . 1991;6:379-390.Article
Nuijs-Beems EM, Oosterhuis JA. Verburg-van der Marel EH, de Wolff-Rouendaal D, van Delft JL, van Best JA.  Tumor destruction by intermediate level hyperthermia . Curr Eye Res . 1990;9:771-780.Article
Jansen W, Haverman J.  Histopathological changes in the skin and subcutaneous tissues of mouse legs after treatment with hyperthermia . Pathol Res Pract . 1990;186:247-253.Article
Makley TA, Havener WH, Newberg J.  Light coagulation of intraocular tumors . Am J Ophthalmol . 1965;60:1082-1089.
Hepler RS, Allen RA, Straatsma BR.  Photocoagulation of choroidal melanoma: early and late histopathologic consequences . Arch Ophthalmol . 1968;79:177-181.Article
Apple DJ, Goldberg MF, Wyhinny G, Levi S.  Argon laser photocoagulation of choroidal malignant melanoma: tissue effects after a single treatment . Arch Ophthalmol . 1973;90:97-101.Article
Noyori KS, Campbell CJ, Rittler MC.  Ocular thermal effects produced by photocoagulation . Arch Ophthalmol . 1963;70:817-822.Article
Priebe LA, Cain CP, Welch AJ.  Temperature rise required for production of minimal lesions in the macaca mulatta retina . Am J Ophthalmol . 1975;79:405-413.
Marmor JB, Hilerio FJ, Hahn GM.  Tumor eradication and cell survival after localized hyperthermia induced by ultrasound . Cancer Res . 1979;39:2166-2171.
Reinhold HS.  Physiological effects of hyperthermia . Recent Results Cancer Res . 1988;107:32-43.
Bornfeld N, Alberti W, Foerster MH, Gerke E, Wessing A, Meyer-Schwickerath G.  Erste Ergebnisse in der perkutanen Strahlentherapie von malignen Melanomen der Aderhaut mit dem Linearbeschleuniger . Klin Monatsbl Augenheilkd . 1984;185:181-184.Article
Guthoff R, Hallermann D.  Ruthenium irradiation of choroidal melanomas: methods of planning and controlling therapy . In: Lommatzsch PK, Blodi FC, eds. Intraocular Tumors . Berlin, Germany: Akademie-Verlag; 1983:302-306.
Eichler Ch, Hertel A, Lommatzsch PK, Fuhrmann P.  Echographische Befunde vor und nach Bestrahlung (106Ru/106Rh) von Aderhautmelanomen . Klin Monatsbl Augenheilkd . 1987;190:17-20.Article
Char DH, Castro JR, Quivey JM, Phillips TL, Irvine AR, Schatz NJ.  Uveal melanoma radiation: 125l brachytherapy versus helium ion irradiation . Ophthalmology . 1989;96:1708-1715.Article
Brown GC, Shields JA, Sanborn G, Augsburger JJ, Savino PJ, Schatz NJ.  Radiation optic neuropathy . Ophthalmology . 1982;89:1489-1493.Article
Brown GC, Shields JA, Sanborn G, Augsburger JJ, Savino PJ, Schatz NJ.  Radiation retinopathy . Ophthalmology . 1982;89:1494-1501.Article
Lommatzsch PK, Lommatzsch R.  Treatment of juxtapapillary melanomas . Br J Ophthalmol . 1991;75:715-717.Article
Garretson BR, Robertson DM, Earle JD.  Choroidal melanoma treatment with iodine 125 brachytherapy . Arch Ophthalmol . 1987;105:1394-1397.Article
Song CW.  Effect of local hyperthermia on blood flow and microenvironment: a review . Cancer Res . 1984;44( (suppl) ):4721s-4730s.
Reinhold HS, Endrich B.  Invited review: tumour microcirculation as a target for hyperthermia . Int J Hyperthermia . 1986;2:111-137.Article
Bujara K, Hallermann D.  Netzhaut-Aderhautnarbe nach Bestrahlung eines malignen Melanoms der Aderhaut mit dem Ruthenium-106-Applikator . Ophthalmologica . 1984;188:29-34.Article
Goodman DF, Char DH, Brooks Crawford J, Stone D, Castro JR.  Uveal melanoma necrosis after helium ion therapy . Am J Ophthalmol . 1986;101:643-645.
Messmer, E, Bornfeld N, Foerster M, Schilling H, Wessing A.  Histopathologic findings in eyes treated with a ruthenium plaque for uveal melanoma . Graefes Arch Clin Exp Ophthalmol . 1992;230:391-396.Article
Bollemeijer JG, Lagendijk JJW, van Best JA, et al.  Effects of microwave-induced hyperthermia on the anterior segment of healthy rabbit eyes . Graefes Arch Clin Exp Ophthalmol . 1989;227:271-276.Article
Burgess SEP, Chang S, Svitra P, Driller J, Lizzi FL, Coleman DJ.  Effect of hyperthermia on experimental choroidal melanoma . Br J Ophthalmol . 1985;69:854-860.Article
Finger PT, Packer S, Paglione RW, Gatz JF, Ho TK, Bosworth JL.  Thermoradiotherapy of choroidal melanoma: a clinical experience . Ophthalmology . 1989;96:1384-1388.Article
Finger PTJ, Svitra PP, McCormick SA, Presser A.  Microwave diathermy of the retina and choroid . Arch Ophthalmol . 1993;11:254-258.Article
Gourgouliatos ZF, Welch AJ, Diller KR, Aggarwal SJ.  Laser-irradiation-induced relaxation of blood vessels in vivo . Lasers Surg Med . 1990;10:524-532.Article
Reese AB.  Pigmented tumors . In: Reese AB, ed. Tumors of the Eye . New York, NY: Harper & Row Publishers Inc; 1976:173-238.