Purpose: : The aim of this study was to evaluate the results of Gamma Knife Radiosurgery (GKR) in sixty uveal melanomas treated between 1994 and 2004 at S.Raffaele Hospital–Milan. Methods: Sixty patients (60 eyes) with uveal melanoma were treated with GKR. The mean age at treatment was 61 years (range 31–77). Thirty–one patients were male and 29 female. The tumor location was 50% at posterior pole, 45% in mid periphery and 5% involved ciliary bodies. The mean initial ultrasound tumor thickness was 6.10 mm (range 3.7–10.6). The mean initial visual acuity was 0.5 (0.05–1.0). Nine patients received 50 Gy, 22 patients 40 Gy and 29 patients 35 Gy (50% isodose). The treatment was performed in a single session and the whole procedure duration time was 3 to 4 hours. Results: The mean follow up was 38.7 months (range 1–115). The Kaplan Meyer 5–years survival rate was 80.1%. The local tumor control was achieved in 55 patients (91.6%). The mean tumor thickness (B–scan) before GKR was 6.1mm and after GKR was 4.09mm (p< 0.0001). Tumor regrowth occurred in 5 patients (8.3%). Four out of five patients with tumor regrowth died for metastasis. The treated eye was retained in 55 patients (91.6%). The mean visual acuity pre–treatment was 4.5/10 and post–treatment was 1.5/10 (p< 0.0001). Five patients (8.3%) were enucleated (3 recurrences and 2 neovascular glaucoma). Acute complications were reversible (conjunctival and retinal hemorrhages). Late vascular complications were ischemic (neovascular glaucoma, retinal neovascularization, optic neuropathy) and exudative (retinal detachment). Conclusions:Our results demonstrated that GKR can achieve a high rate of local tumor control (91.6%) and a high survival rate 80.1%.The eye retention rate was high (91.6%). There was a strong correlation between tumor regrowth and metastatic disease. Visual function may be preserved in selected cases and it is dependent on tumor localization, tumor size and volume of irradiation.
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