Adjuvant chemotherapy and "no touch enucleation" for choroidal melanoma

Purpose. To obtain pilot data regarding the survival rate of patients with medium and large choroidal melanomas treated with adjuvant chemotherapy at the time of enucleation. Methods. Eighty sever tumors (medium = 75%, large = 25%, by Collaborative Ocular Melanoma criteria) were treated by "No Touch Enucleation", a procedure in which the venous drainage of the eye is frozen prior to severing the optic nerve and vortex veins. In addition, the patients received adjuvant chemotherapy consisting of preoperative Hydroxyurea 1500 mg/M² x 2; and BCNU 150 mg/M² and DTIC 350 mg/M² given immediately prior and during enculeation. The patients were followed for death from all causes and death from melanoma. Kaplan Meir survival curves were created, and survival rates were compare to historical controls. Results. The average follow up time was 6.75 years, and only one patient was lost to follow up. The five year survival rate for all tumors (all cause mortality) was 90%, with 95% confidence interval of 83-98%. Conclusions. The present data compares favorably with previous reports of five year survival for patients treated by enucleation for choroidal melanoma. Longer follow up of this group of patients is necessary to determine if the present survival rate will be maintained. Further evaluation of this form of treatment in a controlled randomized trial is warranted.