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Langmann, G; Wackernagel, W; Mayer, C; Tarmann, L; Schwab, C; Wedrich, A.
History of ophthalmic oncology at the Department of Ophthalmology, Medical University Graz (MUG)
SPEKTRUM AUGENHEILKD. 2017; 31(3-4): 135-151. Doi: 10.1007/s00717-017-0369-2 [OPEN ACCESS]
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Führende Autor*innen der Med Uni Graz
Langmann Gerald
Co-Autor*innen der Med Uni Graz
Mayer-Xanthaki Christoph Fidel
Schwab Christoph
Vajda Lisa
Wackernagel Werner
Wedrich Andreas

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The beginning of eye-preserving therapy at the Department of Ophthalmology, Medical University Graz (MUG) dates back to 1985 with the introduction of Ruthenium 106 applicators (Lommatzsch, Vormun). The author sketches in chronological order the introduction and development of different types of gobe-preserving therapies and ends with new treatment modalities of retinoblastoma and metastasizing choroidal melanoma. The former heads of the Department of Ophthalmolgy, beginning with Hofmann, supported the paradigm shift from a radical-surgical concept (enucleation) of intraocular tumors to an globe-preserving therapy despite the absence of large studies with high evidence. Assigning ophthalmologists were justifiably in doubt about the meaningfulness of these new therapeutic concepts, but with their patients' assignments they have been supporting the new paradigm shift to the present day. Uveal melanoma: In 1985, the eye-preserving therapy was introduced by means of Ruthenium 106 applicators in Graz for small and medium-sized choroidal melanomas with aequatorial and anterior localisations. Between 1992 and 2011 the Gamma Knife Radiosurgery was used as an alternative to proton and photon therapy at the Univ. Clinic for Neurosurgery in Graz. Radiosurgery was developed with contributions from other tumor centers for the treatment of large choroidal melanomas or those with posterior localization. Transpupillary thermotherapy (TTT): Transpupillary thermotherapy (TTT) was developed in an animal model in 1995 in Leiden by Osterhuis and Journ,e de Korver for the treatment of flat posterior localized melanomas. The therapy has been discredited and neglected due to an increased rate of recurrences in individual tumor centers, but should be evaluated again on the basis of good personal experience. Endoresection: Uveal melanomas are going to be resected after pre-irradiation because of the large tumor volume or a persisting retinal detachment by means of vitrectomy techniques. The Leksell Gamma Knife (LGK) was used as an irradiation technology in Graz and in Essen. Biopsy: Biopsies either with a transvitral or transscleral approach have been carried out for several years for histopathological, genetic and microbiological studies. New microbiological findings will hopefully lead to the development of promising new systemic therapeutic concepts. Retinoblastoma: In contrast to choroidal melanoma, adjuvant chemotherapy is highly effective in chemoreduction of retinoblastomas prior globe preserving therapy. Brachytherapy with Ruthenium 106 applicators, triple freeze/thaw cryotherapy and laser therapy have been used for decades at the deparment. TTT with or without simultaneous chemotherapy (chemothermotherapy) was recently introduced. New therapy concepts such as intrabulbar chemotherapy (already in use) as well as intraarterial chemotherapy (shortly before implementation) are already in routine. Since 2003, retinoblastomas have been treated in Graz for the first time in a therapy optimising study. So called RBA2003 was developed by the Department of Paediatric Hematology/Oncology in Graz together with the Department of Ophthalmology. The University Clinicum Graz establishes itself as a reference center for retinoblastomas and pseudoretinoblastomas in Austria and surrounding countries and has been receiving inquiries and patient assignments from the Alps Adria countries, Switzerland, Bulgaria, Czech Republic, Romania and Russia. Wedrich, currently chairman of the Department of Ophthalmology, Medical University Graz, promoted the development of the retinoblastoma competence center in terms of personnel, instrumentation and logistical aspects. In 2015, the Univ. Clinicum Essen developed an expanded international protocol based on the protocol RBA2003, according to which patients from Graz and Essen are now treated and evaluated together. This protocol, in turn, is considered in an EU application initiated by Chandada (Buenos Aires, Barcelona) for an uniform treatment of retinoblastomas in Europe. In 2003 the NGO, Light for the World, asked the Ophthalmic Oncology group Graz to examine the framework conditions for the establishment of a retinoblastoma center in Mozambique/Africa. Recently the Ophthalmic Oncology group of the Department of Ophthalmology was integrated into the Comprehensive Cancer Center (CCC) of the LKH Univ. Clinicum Graz. The concept of globe-preserving therapy established at the Department of Ophthalmology was confirmed 32 years after our introduction by the largest multicentric study (COMS study) in the USA, according to which no difference in survival between enucleation and globe-retaining therapy (Iodine 125) was found in small and medium-sized choroid melanomas. The unchanged (sometimes very bad) prognosis for over 30 years may possibly be improved in due time by new treatment concepts. The basis for these encouraging developments are cutting-edge findings from cytogenetic and molecular biological research.

Find related publications in this database (Keywords)
Ophthalmic oncology service
Department of Ophthalmology
Medical University Graz ( MUG)
Comprehensive Cancer Center Graz (CCC)
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