Radiation complications, Toxic Tumor Syndrome prevention

Purpose After large melanomas radiotherapy (I‐125, Ru‐106 brachytherapy or proton‐beam) tumor is damaged, which can cause the development of radiation‐induced complications. Large tumor resection under the scleral flap (egzoresection) or during pars plana vitrectomy (endoresection) can prevent Toxic Tumor Syndrome. Aim To present choroidal melanoma endoresections results. Tumors were resected in the Department of Ophthalmology and Ocular Oncology at the University Hospital in Krakow. Methods The study included 10 patients with large melanoma located in the posterior pole after the proton beam irradiation. Patients were stratified for resection because of the risk of Toxic Tumor Syndrome. Pars plana vitrectomy and tumor endoresection was performed in all cases with endophotocoagulation and silicone oil endotamponade. Results Removed melanomas were localized predominantly in the posterior pole of the eye, tumor base diameter ranged from 11.3 to 15.2 mm, tumor thickness ranged 5.2 to 9.1 mm. Endoresection was performed 1 to 3 months after proton beam irradiation. Intraoperative complications include minor bleeding occurred in all patients, postoperatively in 1 patient intraocular inflammation (treated with good effect intravitreal injections of steroids) and in 1 case of PVR. There was no recurrence of the neoplasm during the observation period. Conclusions Choroidal melanoma endoresection should be used in some cases of large tumors localized back to the equator of the eye, mainly in the posterior pole of the eye. This prevents Toxic Tumor Syndrome and tumor recurrence.