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PubMed2006

Extended follow-up of small melanocytic choroidal tumors treated with transpupillary thermotherapy.

OBJECTIVE: To report our longer-term follow-up observations in patients with small choroidal melanomas primarily treated with transpupillary thermotherapy (TTT). METHODS: In this noncomparative interventional case series, 40 patients with small melanocytic tumors of the choroid (thickness <3.5 mm) underwent TTT. Follow-up examinations including ophthalmoscopy, ultrasonography, and fundus photography were conducted at 24 to 48 hours, 2 to 6 weeks, and 6-month intervals after treatment. RESULTS: Forty patients (mean age, 58 years) with small melanocytic tumors underwent TTT. Mean follow-up in all patients was 42 months. In most cases TTT resulted in tumor regression. Thirty-one (77.5%) of 40 tumors did not recur after initial treatment with TTT. In 5 (12.5%) of 40 tumors with initial basal diameters ranging from 4 x 2.75 mm to 7.5 x 6 mm and a mean initial thickness of 2.0 mm, edge recurrences developed, which were satisfactorily treated with additional TTT (4 cases) or cryotherapy (1 case). The mean interval between initial TTT and recurrence in this subgroup was 15 months (range, 7-22 months). Of 36 eyes that were successfully treated with TTT or cryotherapy, 26 eyes (72%) had posttreatment visual acuity better than or equal to pretreatment visual acuity. Four (10%) of 40 tumors were not controlled with TTT and eventually required brachytherapy (n = 1), proton radiation (n = 1), or enucleation (n = 2). The initial basal diameters of these tumors ranged from 7.5 x 7.5 mm to 9 x 7.5 mm, with a mean initial thickness of 2.6 mm. The mean interval between treatment and determination of treatment failure was 22 months (range, 7-30 months). CONCLUSIONS: Transpupillary thermotherapy resulted in tumor regression of most small melanocytic choroidal tumors. Tumor edge recurrences were successfully treated with additional TTT in most cases. Four tumors required irradiation or enucleation because of treatment failures with TTT. Transpupillary thermotherapy as a stand-alone therapy is insufficient for some small choroidal melanomas.

Adult↗
PubMed2003

Thermotherapy for treatment of osteoarthritis.

BACKGROUND: Osteoarthritis is a degenerative joint disease that affects mostly the weight-bearing joints in the knees and hips. As the affected joint degenerates pain and restriction of movement often occur. Inflammation can also occur sometimes resulting in edema of the joint with OA. Treatment focuses on decreasing pain and improving movement. OBJECTIVES: To determine the effectiveness of thermotherapy in the treatment of OA of the knee. The outcomes of interest were relief of pain, reduction of edema, and improvement of flexion or range of motion (ROM) and function. SEARCH STRATEGY: Two independent reviewers selected randomized and controlled clinical trials with participants with clinical and/or radiological confirmation of OA of the knee; and interventions using heat or cold therapy compared with standard treatment and/or placebo. Trials comparing head to head therapies, such as two different types of diathermy, were excluded. SELECTION CRITERIA: Randomized and controlled clinical trials including participants with clinical or radiographical confirmation of OA of the knee; and interventions using heat or cold compared to standard treatment or placebo were considered for inclusion. DATA COLLECTION AND ANALYSIS: Study results were extracted by two independent reviewers. Outcomes were continuous in nature (pain, strength, improvement) and were analyzed by weighted mean difference using a fixed effects model. Graphical data were used when table data were not available. MAIN RESULTS: Three randomized controlled trials, involving 179 patients, were included in this review. The included trials varied in terms of design, outcomes measured, cryotherapy or thermotherapy treatments and overall methodological quality. In one trial, administration of 20 minutes of ice massage, 5 days per week, for 3 weeks, compared to control demonstrated a clinically important benefit for knee OA on increasing quadriceps strength (29% relative difference). There was also a statistically significant improvement, but no clinical benefit in improving knee flexion ROM (8% relative difference) and functional status (11% relative difference). Another trial showed that cold packs decreased knee edema. REVIEWER'S CONCLUSIONS: Ice massage compared to control had a statistically beneficial effect on ROM, function and knee strength. Cold packs decreased swelling. Hot packs had no beneficial effect on edema compared with placebo or cold application. Ice packs did not effect pain significantly compared to control in patients with OA. More well designed studies with a standardized protocol and adequate number of subjects are needed to evaluate the effect of thermotherapy in the treatment of OA of the knee.

Cryotherapy↗
PubMed2002

Focused microwave phased array thermotherapy for primary breast cancer.

BACKGROUND: A pilot safety study of focused microwave phased array thermotherapy in the treatment of primary breast carcinomas was conducted. METHODS: Ten patients with breast carcinomas beneath the skin surface that ranged in maximal clinical size from 1 to 8 cm (mean, 4.3 cm) were treated with the breast compressed in the prone position. We planned to deliver a tumor thermal dose equivalent to 60 minutes at 43 degrees C. Breast imaging and pathology data were used to assess efficacy. RESULTS: For the 10 patients, the mean tumor equivalent thermal dose was 51.7 minutes, the mean peak tumor temperature was 44.9 degrees C, and the mean treatment time was 34.7 minutes. Ultrasound imaging demonstrated a significant reduction in tumor size (mean, 41%) 5 to 18 days after thermotherapy in 6 (60%) of 10 patients. A significant tumor response on the basis of reduction in tumor size or significant tumor cell kill occurred in 8 (80%) of 10 patients. CONCLUSIONS: With sufficient skin cooling, delivery of focused microwave phased array thermotherapy is safe in treating breast carcinomas when used alone, and some potential efficacy was demonstrated at the tumor thermal doses administered. Increased tumor thermal dose efficacy studies in larger patient populations for improved breast conservation should be investigated.

Adult↗
PubMed1998

Transurethral microwave thermotherapy for benign prostatic hyperplasia--experience with the Prostcare.

Transurethral microwave thermotherapy for benign prostatic hyperplasia with the Prostcare has been used in our department since April 1992. Our research has mainly been focused on strategies for development of the apparatus, accessories, and treatment performance to find an optimal means of treatment. The development to high-power thermotherapy has demonstrated a significant improvement in symptom and quality-of-life scores, maximal flow rate, and residual and voided urinary volume after 6 months. Pressure-flow data have additionally demonstrated a significant decrease in the minimal urethral opening pressure. The improvement in outcome after high-power thermotherapy is associated with an increased short-term morbidity as compared with low-power treatment. The outcome is dependent on several factors: power and intraprostatic temperatures, treatment performance technique, configuration of heat distribution of the antennae, and the localization of maximal heat in the prostatic urethra.

Aged↗
PubMed1998

Case selection for high-energy transurethral microwave thermotherapy.

Transurethral microwave thermotherapy (TUMT) is a minimally invasive outpatient procedure for the treatment of benign prostatic hyperplasia (BPH). Different devices and operating software have been used in various clinical trials. The objective of this study was to identify the possible baseline parameters that could be used to identify the best responders to different microwave devices and treatment programs. Data on three different high-energy thermotherapy devices (Urowave, Prostalund, and Prostatron) were collected and analyzed. At 1 year of follow-up, 166 patients were available for the Prostatron system. In all, 52 had a > or = 50% change in both symptom score and peak flow rate, whereas 114 patients were considered nonresponders. Responders were characterized at baseline by a lower peak flow rate (8.80 versus 10.48 ml/s, P < or = 0.0001) and a larger degree of outlet obstruction as measured by the URA parameter (45.33 versus 36.70 cmH2O, P < or = 0.0300); a larger energy dose was delivered to this group during treatment (173.36 versus 156.40 kJ, P < or = 0.0258). A total of 19 patients were available from the Prostalund cohort. No significant difference was found in the values recorded for baseline parameters between responders (5 patients) and nonresponders (14 patients). Stratification of 143 patients treated with the Urowave resulted in 29 responders (> or = 50% improvement in both Qmax and AUA score) at 6 months of follow-up, with a significant difference being found in the baseline value recorded for peak flow rate (7.0 versus 8.0 ml/s, P < or = 0.026). At 12 months, however, this significance difference could no longer be found. In conclusion, baseline parameters with significant predictive value for a clinical response could be identified for the Prostatron device only. The results of this study further confirm the importance of an extensive laboratory and clinical research program for a fuller understanding of the clinical response obtained with a certain microwave device and a particular treatment software and for provision of the greatest possible advantage from these new alternative treatments. Further exploratory work is required for a better understanding of the role of other parameters such as prostate tissue architecture and vascularity, the microwave frequency, the applicator design, the intraprostatic temperature, and the treatment duration in the clinical response to microwave thermotherapy.

Diathermy↗
PubMed2005

[Transpupillary thermotherapy for occult choroidal neovascularizations].

PURPOSE: This contribution describes the results of transpupillary thermotherapy (TTT) for age-related exudative macular degeneration (AMD) with regression. PATIENTS AND METHODS: In exudative AMD with occult choroidal neovascularization (CNV), transpupillary thermotherapy (TTT) was performed using a diode laser (Iridex) in unselected patients. Before therapy and 1, 3, and 6 months after the initial treatment the patients were examined clinically. Additionally threshold testing in the 10 degrees field (Humphrey) and fluorescein angiographies were documented at all check-ups. RESULTS: With respect to vision, differences in the slope of the regression lines between small, medium, and large CNV were significant (p<0.001). The slope of the regressions lines was significant except for small CNV. Regarding the 10 degrees field (Humphrey), there were no statistical differences in the slope of the regression lines (p=0.867). CONCLUSIONS: Transpupillary thermotherapy with small CNV did not show a statistically significant decrease of VA. Thus, in clinical terms early treatment of occult CNV with TTT seems to be able to prevent a further loss of visual acuity.

Aged↗
PubMed1993

Sham versus transurethral microwave thermotherapy in patients with symptoms of benign prostatic bladder outflow obstruction.

Transurethral microwave thermotherapy (TUMT) is a single-session, minimally invasive outpatient treatment for patients with symptoms of benign prostatic bladder outflow obstruction. We designed a prospective randomised trial to identify any placebo response. Patients with a Madsen symptom score over 8 for at least 6 months were eligible for study. Two measurements of urinary flow less than 15 mL/s and a residual urine of under 350 mL were also required for entry. Patients with renal dysfunction, upper urinary tract disease, co-existing bladder disease, and malignant prostatic change were excluded. 43 patients were studied: 21 were randomised to receive a sham treatment and 22 to thermotherapy. Sham treatments were done with the urethral applicator in situ. 40 patients were available for evaluation at 3 months. 2 patients had delayed follow-up and 1 patient randomised to TUMT has undergone transurethral resection. The thermotherapy group showed a 70% decrease (from 14.5 to 4.3) in the mean Madsen score, a 53% increase in flow-rate (8.5 to 13.0 mL/s), and 92% decrease in residual urine volume (147 to 12 mL). No significant change was seen in these mean indices in the sham group. There was no difference in the main complication of transient haematuria between the two groups. However, there was a 22% frequency of acute retention in the TUMT group. The results show little significant placebo component to the subjective and objective improvement that occurs in patients who have received TUMT.

Aged↗
PubMed1995

Ultrasound-guided microwave thermotherapy on a VX-2 carcinoma implanted in rabbit kidney.

A temperature greater than 60 degrees C was maintained for 60 s within a 5-mm radius of a microwave electrode implanted in a rabbit kidney using 2450 MHz at 100 W for 30 s. Histological examination revealed complete coagulation necrosis in that area. VX-2 cells were inoculated into the kidneys of 10 rabbits. One week later, five rabbits received ultrasound-guided microwave thermotherapy, and the remaining five rabbits received no treatment. All rabbits with microwave thermotherapy had a complete response to treatment while all rabbits without therapy died of cancer within 6 weeks of the VX-2 implantation. These results indicate that ultrasound-guided microwave thermotherapy has the potential of being a nephron-salvaging treatment for small renal tumors.

Animals↗
PubMed2004

Transpupillary thermotherapy for subfoveal choroidal neovascularization associated with choroidal nevus.

PURPOSE: To describe a patient with classic subfoveal choroidal neovascularization (CNV) associated with choroidal nevus, which was successfully treated using transpupillary thermotherapy. DESIGN: Interventional case report. METHODS: A 53-year-old woman underwent ophthalmologic evaluation, including fluorescein and indocyanine green angiography. Clinical and angiographic data were prospectively analyzed to evaluate visual acuity changes and angiographic evolution. RESULTS: Three months after transpupillary thermotherapy, visual acuity had improved from 20/100 to 20/40. Fluorescein and indocyanine green angiograms showed absence of leakage from CNV. Final visual acuity was 20/32 after a 15-month follow-up. CONCLUSIONS: Transpupillary thermotherapy may be a viable option for subfoveal CNV associated with CN, although further studies are needed to establish the correct setting.

Choroid Neoplasms↗
PubMed2005

Infrared thermotherapy: from laboratory to clinic.

Thermotherapy by the transpupillary route is an effective outpatient eye-salvaging therapy for intraocular tumors. It does not require surgery, it can be repeated, and it does not affect the healthy structures of the eye. Thermotherapy by the transscleral route is under investigation and may have potential in the treatment of choroidal melanomas. The indications for chemoreduction, thermochemotherapy, and thermotherapy for retinoblastoma remain under investigation.

Animals↗
PubMed2004

Long-term pooled analysis of multicenter studies of cooled thermotherapy for benign prostatic hyperplasia results at three months through four years.

OBJECTIVES: To determine the long-term efficacy of cooled thermotherapy in the treatment of lower urinary tract symptoms of clinical benign prostatic hyperplasia. METHODS: A total of 541 men underwent cooled thermotherapy treatment in six multicenter studies in the United States, England, and Canada. Both fixed and random effects models were used to pool the data across the six studies. The treatment response was measured as the difference between the urinary tract symptoms at baseline versus those at 3, 12, 24, 36, and 48 months after therapy. The treatment response included changes in the American Urological Association Symptom Score (AUA symptom score), peak urinary flow rate in milliliters per second (Qmax), and quality of life (QOL). RESULTS: The baseline measures were comparable across the studies. At 3 months, the AUA symptom score had improved by a mean of 11.6 (55%), Qmax by a mean of 4.0 (51%), and QOL by a mean of 2.3 (53%). These changes persisted with only slight attenuation through 48 months (corresponding mean changes of 43%, 35%, and 50%). These changes were highly statistically significant (P <0.0001 to 0.01). An improvement of at least 25% was achieved for the AUA symptom score and QOL by more than 85% of men and by more than 65% of men for Qmax. CONCLUSIONS: This pooled analysis of six multicenter studies of cooled thermotherapy, involving 541 men, found highly significant improvements in AUA symptom score, Qmax, and QOL. The results were highly consistent across the studies. The improvements reflected changes from baseline values of 45% to 50% for AUA symptom score and QOL and 35% to 40% for Qmax at a follow-up duration up to 48 months after therapy. The level of improvement for all three measures remained high at 48 months, indicating that the response is durable.

Aged↗
PubMed2006

Interstitial temperature mapping during Prolieve transurethral microwave treatment: imaging reveals thermotherapy temperatures resulting in tissue necrosis and patent prostatic urethra.

OBJECTIVES: Temperature mapping of the prostate during transurethral microwave thermotherapy and imaging of the resultant zones of tissue necrosis have been previously performed using several commercial systems. This study was performed using the Prolieve Thermodilatation System, which simultaneously compresses the prostate with a 46F balloon circulating heated fluid and delivering microwave energy into the prostate. METHODS: Interstitial temperature mapping during Prolieve treatment was performed on 10 patients with benign prostatic hyperplasia using 24 temperature sensors arrayed throughout the prostate. Voiding cystourethrograms were performed on 3 additional patients treated without temperature mapping to document the patency of the prostatic urethra 1 hour after treatment. Gadolinium-enhanced magnetic resonance imaging studies were performed on all patients 1 week after treatment to determine the extent and pattern of tissue necrosis resulting from transurethral microwave thermotherapy. RESULTS: Interstitial temperature mapping found that the heating pattern generated by the Prolieve system created average peak temperatures of 51.8 degrees C an average of 7 mm away from the prostatic urethra. These temperatures were greater near the bladder neck and mid-gland than toward the prostatic apex. Subtherapeutic temperatures were seen adjacent to the urethra, consistent with the viable tissue seen on gadolinium-enhanced magnetic resonance imaging sequences. Magnetic resonance imaging also revealed necrotic zones that were consistent with sustained temperatures greater than 45 degrees C. Voiding cystourethrograms showed widely patent prostatic urethras 1 hour after treatment. CONCLUSIONS: Transurethral microwave thermotherapy with the Prolieve Thermodilatation System produced sustained therapeutic temperatures that resulted in tissue necrosis while maintaining viable tissue surrounding a temporarily dilated prostatic urethra.

Body Temperature↗
PubMed2003

Retinal tear and detachment after transpupillary thermotherapy for choroidal melanoma.

PURPOSE: To report a side effect of transpupillary thermotherapy for choroidal melanoma. DESIGN: Small case series. METHODS: Review of clinical charts and photographs in a private retina practice. RESULTS: Retinal tears developed in two patients after transpupillary thermotherapy for choroidal melanoma. In one patient a secondary rhegmatogenous retinal detachment developed. CONCLUSIONS: Transpupillary thermotherapy can result in vitreous traction on the retina over the choroidal tumor, which can lead to a retinal tear and to retinal detachment. Patients should be warned about this possibility and advised to be examined should photopsias or new floaters develop after treatment.

Aged↗
PubMed1998

Tolerability of high energy transurethral microwave thermotherapy with topical urethral anesthesia: results of a prospective, randomized, single-blinded clinical trial.

PURPOSE: We determine the tolerability of high energy transurethral microwave thermotherapy with topical urethral anesthesia alone without supplementary systemic sedoanalgesia. MATERIALS AND METHODS: A total of 45 patients with symptomatic benign prostatic hyperplasia were randomized to high energy transurethral microwave thermotherapy using either topical urethral anesthesia alone (topical anesthesia group) or topical anesthesia with adjunctive intravenous sedoanalgesia (sedoanalgesia group). Pain was evaluated sequentially by means of a 0 to 10 visual analog scale score. Posttreatment followup included determinations of International Prostate Symptom Score, peak flow rate, post-void residual urine, and quality of life score at 6 and 12 weeks. RESULTS: Upon commencement of microwave treatment mean visual analog scale score was 1.3 (95% confidence interval [CI], 1.0 to 1.7) in the sedoanalgesia group and 1.4 (95% CI, 1.0 to 1.9) in the topical anesthesia group. During therapy visual analog scale score increased to a peak at 30 minutes of 2.0 (95% CI, 1.6 to 2.4) and 2.2 (95% CI, 1.7 to 2.6) in the sedoanalgesia and topical anesthesia groups, respectively. Thereafter, visual analog scale score continuously declined, falling to 0.1 (95% CI, 0.0 to 0.2) and 0.2 (95% CI, 0.0 to 0.3) in the 2 respective groups by 1 hour following conclusion of the treatment period. There was no statistically significant difference between the groups in the treatment profile of visual analog scale scores (p = 0.701). Significant posttreatment improvements were demonstrated in International Prostate Symptom Score, peak flow rate, post-void residual urine and quality of life scores but there were no significant differences between the groups in the magnitude of improvement in these outcome measures. CONCLUSIONS: High energy transurethral microwave thermotherapy is well tolerated by patients under topical anesthesia alone and, therefore, can be administered in the outpatient setting without potent medications that necessitate intensive patient monitoring, pose risks for side effects and add to treatment costs.

Aged↗
PubMed1998

Temperature controlled high energy transurethral microwave thermotherapy for benign prostatic hyperplasia using a heat shock strategy.

PURPOSE: We evaluate the clinical outcome of temperature controlled high energy transurethral microwave thermotherapy for benign prostatic hyperplasia using heat shock strategy. MATERIALS AND METHODS: A total of 32 patients were evaluated 3, 6 and 12 months after thermotherapy according to symptom scores, uroflowmetry, residual urine volume, sexual functions and side effects. RESULTS: At 12 months symptom score and maximum flow rate had improved 79% from 13.5 to 2.9, and 71% from 10.0 to 17.1 ml. per second, respectively. Furthermore, bother and quality of life scores and residual and voided urine volumes had improved significantly. However, a higher morbidity than previously shown after lower energy protocols was demonstrated. Treatment influenced sexual functions, especially ejaculation quality, and after treatment 29% of the patients had anejaculation. Significantly less energy was required for prostate volumes 40 ml. or greater to reach the same intraprostatic temperature level as those less than 40 ml. as demonstrated by radiometry. CONCLUSIONS: High energy transurethral microwave thermotherapy using a heat shock strategy is an effective treatment for benign prostatic hyperplasia and produces a better outcome than shown with lower energy protocols. However, the morbidity is not negligible and ejaculation quality is affected. Less relative energy is needed for large than small prostate volumes to reach the same intraprostatic temperature level as demonstrated by radiometry.

Ejaculation↗
PubMed2002

Feedback microwave thermotherapy versus TURP for clinical BPH--a randomized controlled multicenter study.

OBJECTIVES: To compare the outcome of a microwave thermotherapy feedback system that is based on intraprostatic temperature measurement during treatment (ProstaLund Feedback Treatment or PLFT) with transurethral resection of the prostate (TURP) for clinical benign prostatic hyperplasia (BPH) in a randomized controlled multicenter study. The safety of the two methods was also investigated. METHODS: The study was performed at 10 centers in Scandinavia and the United States. A total of 154 patients with clinical BPH were randomized to PLFT or TURP (ratio 2:1); 133 of them completed the study and were evaluated at the end of the study 12 months after treatment. Outcome measures included the International Prostate Symptom Score (IPSS), urinary flow, detrusor pressure at maximal urinary flow (Qmax), prostate volume, and adverse events. Patients were seen at 3, 6, and 12 months. Responders were defined according to a combination of IPSS and Qmax: IPSS 7 or less, or a minimal 50% gain, and/or Qmax 15 mL/s or greater or a minimal 50% gain. RESULTS: No significant differences in outcome at 12 months were found between PLFT and TURP for IPSS, Qmax, or detrusor pressure. The prostate volume measured with transrectal ultrasonography was reduced by 30% after PLFT and 51% after TURP. Serious adverse events related to the given treatment were reported in 2% after PLFT and in 17% after TURP. Mild and moderate adverse events were more common in the PLFT group. With the criteria mentioned above, 82% and 86% of the patients were characterized as responders after 12 months in the PLFT and TURP groups, respectively. The post-treatment catheter time was 3 days in the TURP group and 14 days in the PLFT group. CONCLUSIONS: The outcome of microwave thermotherapy with intraprostatic temperature monitoring was comparable with that seen after TURP in this study. From both a simplicity and safety point of view, PLFT appears to have an advantage. Taken together, our findings make us conclude that within a 1-year perspective microwave thermotherapy with PLFT is an attractive alternative to TURP in the treatment of BPH.

Humans↗
PubMed2005

Resistance to tumour challenge after tumour laser thermotherapy is associated with a cellular immune response.

Previous studies in our laboratory have shown that interstitial laser thermotherapy (ILT) of an experimental liver tumour is superior to surgical excision, at least partly due to a laser-induced immunological effect. The aim of the present study was to investigate the time-response relationship of the ILT-induced immunisation and the cellular response of macrophages and lymphocytes. A dimethylhydrazine-induced adenocarcinoma was transplanted into the liver of syngeneic rats. Rats with tumour were treated 6-8 days later (tumour size 0.25-0.40 cm(3)) with ILT of tumour or resection of the tumour-bearing lobe. Two groups of rats without tumour were treated with resection of a normal liver lobe or ILT of normal liver. A challenging tumour was implanted into the liver of each rat 2, 5 or 10 weeks after primary treatment. Rats were killed 6, 12 and 48 days (or earlier due to their condition) after challenge (n = 8 in all groups). Immunohistochemical techniques were used to determine lymphocytes (CD8, CD4) and macrophages (ED1, ED2) in rats having had treatment of a primary tumour. Interstitial laser thermotherapy of the first tumour was followed by eradication of challenging tumour and absence of tumour spread. This contrasted with rapid growth and spread of challenging tumour in the other groups. In the challenging vital tumour tissue and in the interface between the tumour and surroundings, the number of ED1 macrophages and CD8 lymphocytes was higher in rats having been treated with the ILT of tumour than in those having undergone resection of the tumour-bearing lobe. The number of ED2 macrophages and CD4 lymphocytes was low and did not vary between these two groups. Interstitial laser thermotherapy elicited an immune response that eradicated a challenging tumour and was associated with increased numbers of tumour-infiltrating macrophages and CD8 lymphocytes.

Adenocarcinoma↗
PubMed2003

Serum melatonin levels following enucleation and transpupillary thermotherapy in patients with choroidal melanoma.

PURPOSE: To study serum melatonin levels in patients with choroidal melanoma preoperatively and following enucleation and transpupillary thermotherapy. METHODS: Forty patients with preoperative choroidal melanoma were included in the study. Of these, 15 patients underwent enucleation (group 1) and 25 patients received transpupillary thermotherapy (group 2). A further 20 patients without melanoma acted as age-matched controls. Serum melatonin levels were determined 1 day preoperatively, and at the first and sixth months postoperatively using ELISA. RESULTS: Preoperative serum melatonin levels were highest in group 2 followed by group 1, but this was not statistically significant compared to controls. Postoperatively, a constant decrease of serum melatonin was observed in both groups after the first month, which reached statistical significance at the sixth month (P = 0.003). Also, a significant regression in tumour thickness was documented in group 2 (P = 0.003). Three patients in group 1 developed hepatic metastases. CONCLUSIONS: Patients with choroidal melanomas had higher levels of serum melatonin compared to individuals without tumours. Smaller tumours were associated with more elevated melatonin levels compared to larger tumours. Serum melatonin levels fell considerably following enucleation and transpupillary thermotherapy.

Adult↗