Нужна помощь
 

Уважаемые коллеги, у моего друга врача обнаружили меланому глаза. Размеры 15 на 10 мм. Подскажите, такой размер- это средняя или большая меланома? Сейчас он в Москве, в институте им. Гельмгольца.
Предлагают энуклеацию. Знаю есть еще такие методы лечения, как брахитерапия I 125, а также облучение протонами и на гамма-камере.
Применяется ли такое лечение в России и где? Спасибо.

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The Collaborative Ocular Melanoma Study:
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Tumor size

Uveal melanoma most often assumes a nodular or dome-shaped configuration, but occasionally tumors can be flat or diffuse and involve extensive areas of the uvea with little elevation.

Tumor size classifications according to boundary lines are as follows:

Small: Range from 1 mm to 3 mm in apical height and have a basal diameter of at least 5 mm.[1]
Medium: Range from 2 mm to 3 mm up to 10 mm in apical height and have a basal diameter of less than 16 mm.[2]
Large: Greater than 10 mm in apical height or have a basal diameter of at least 16 mm.[3]
Diffuse: Horizontal, flat growth pattern, with the thickness of the tumor measuring approximately 20% or less than the greatest basal dimension; this uncommon variant of uveal melanoma seems to have a poorer prognosis.[4]



Vestn Oftalmol. 1997 May-Jun;113(3):14-6.

[Criteria for assessing the efficacy of brachytherapy of uveal melanomas, complications of therapy and there prevention]

[Article in Russian]

Brovkina AF, Zarubei GD, Val'skii VV.

Department of Ophthalmooncology and Radiology, Moscow NII of Eye Diseases.

The authors assess the efficacy of brachytherapy of uveal melanomas in 954 patients. Strontium ophthalmoapplicators were used in 652, rutenium ones in 302 patients. As a rule, Sr applicators were sutured in patients with tumors up to 3.5 mm thick and Ru ones in cases with tumors thicker than 3.5 mm. A special program was used for individual approach and improving the accuracy of planning. A total of 74.5% of patients have been followed up for at least 3 years, with check-ups every 3-6 months. The effect of brachytherapy was considered positive in cases with complete resorption or at least 50% decrease of the tumor and a stable clinical picture for 9-12 months. In 60% of patients the tumor regressed completely, in 16% partially, and in 24% there were signs of activation of melanoma growth one year after treatment. The frequency of radiation complications was as follows: retinopaty, 3.15%; neuroretinopathy, 1.1%; hemophthalmia, 0.9%; neovascular glaucoma, 1.1%; cataract, 0.63%. The incidence of radiation complications increases with increase of the applicator power and rigidity of exposure. Computer planning of brachytherapy with due consideration for the size of the tumor and the eye and localization of the neoplasm for each case will help decrease the incidence of complications.

The COMS Randomized Trial of Iodine 125 Brachytherapy for Choroidal Melanoma, III: Initial Mortality Findings
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In summary, the COMS Group has documented in a carefully designed and conducted randomized trial of 125I brachytherapy vs enucleation among 1317 patients suitable for either treatment that survival rates were essentially the same over a follow-up period of 2 to 12 years. Possibly the most encouraging finding is that survival of patients who met COMS criteria and were treated and followed according to the COMS protocol is better than projected when the COMS was designed in 1985, with 5-year survival rates of better than 80% in both treatment arms. The combined 5-year survival rate was 82% (95% CI, 80%-84%). Among patients treated with 125I brachytherapy, 85% retained their eyes for 5 years or longer; 37% had visual acuity better than 20/200 in the irradiated eye 5 years after treatment. These findings are applicable to patients who meet the criteria used to select patients for the randomized trial; ophthalmologists should be cautious when considering extrapolation of the findings to other patients with choroidal melanoma. Follow-up of COMS patients will continue through July 2003 to provide data through 5 years of follow-up for all patients and to refine estimates of survival rates, complication rates, and quality of life outcomes during 5 to 15 years after treatment. When the COMS is completed, ophthalmologists will be in a better position to answer with confidence the question posed in 1986: "Do I take the eye out or leave it in?"