Finger P T, Berson A, Szechter A
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York University School of Medicine, New York 10021, USA.
Ophthalmology. 1999 Mar;106(3):606-13. doi: 10.1016/S0161-6420(99)90124-0.
To describe the first clinical experience with palladium-103 (103Pd) ophthalmic plaque radiotherapy for choroidal melanoma.
Phase-I (nonrandomized) clinical trial.
Eighty patients with uveal melanomas were diagnosed by clinical examination, found to be negative for metastatic disease, and offered 103Pd radioactive plaque treatment. Nine patients were concurrently treated with microwave hyperthermia.
Palladium-103 ophthalmic plaque radiotherapy was employed for each patient. Eye plaques were sewn to the episclera to cover the base of the intraocular tumor, radiation was continuously delivered over 5 to 7 days, and then the plaques were removed. A mean apical dose of 81 Gy was delivered.
The authors evaluated the ease of use of 103Pd seeds within standard gold eye plaques. Patient-related outcomes were control of tumor growth, change in visual acuity, the development of radiation damage (retinopathy, optic neuropathy, and cataract), and metastatic disease.
From September 1990 to December 1997, 80 patients were treated with 103Pd and followed for an average of 38 months. Two patients were lost to follow-up. During this time, the authors found that 103Pd seeds were equivalent to iodine-125 (125I) with respect to plaque manufacture and ease of dosimetric calculations. Two patients in this series were treated for tumor recurrence after 125I plaque radiotherapy. They both failed secondary 103Pd treatment and were enucleated. When 103Pd was used as a primary treatment, it controlled the growth of 75 of 78 tumors (96%). Overall, there have been six enucleations: three failures of primary treatment, two failures of retreatment, and one for neovascular glaucoma. Visual acuity evaluations at the 36-month follow-up visit (including the enucleated patients) revealed that 38% of eyes had decreased 3 or more lines of vision, and 77% were 20/200 or better.
Palladium-103 plaque radiotherapy can be used to treat uveal melanomas. Compared with 125I, computerized dosimetry suggests a more favorable dose distribution with 103Pd. Treatment of most patients resulted in tumor shrinkage and preservation of functional vision. The authors have noted no complications that might preclude the use of 103Pd ophthalmic plaque radiotherapy for choroidal melanoma.
描述钯 - 103（¹⁰³Pd）眼内敷贴放射治疗脉络膜黑色素瘤的首例临床经验。
I期（非随机）临床试验。
80例葡萄膜黑色素瘤患者经临床检查确诊，未发现转移病灶，并接受¹⁰³Pd放射性敷贴治疗。9例患者同时接受微波热疗。
对每位患者采用¹⁰³Pd眼内敷贴放射治疗。将眼用敷贴缝合至巩膜以覆盖眼内肿瘤基底，连续放射5至7天，然后移除敷贴。平均顶点剂量为81 Gy。
作者评估了¹⁰³Pd籽源在标准金制眼用敷贴中的易用性。与患者相关的结果包括肿瘤生长的控制、视力变化、放射损伤（视网膜病变、视神经病变和白内障）的发生以及转移疾病。
从1990年9月至1997年12月，80例患者接受了¹⁰³Pd治疗，平均随访38个月。2例患者失访。在此期间，作者发现¹⁰³Pd籽源在敷贴制作和剂量计算的简便性方面与碘 - 125（¹²⁵I）相当。本系列中有2例患者在¹²⁵I敷贴放射治疗后因肿瘤复发接受治疗。他们二次¹⁰³Pd治疗均失败并接受了眼球摘除术。当¹⁰³Pd用作初始治疗时，它控制了78例肿瘤中的75例（96%）的生长。总体而言，共进行了6次眼球摘除术：3例初始治疗失败，2例再次治疗失败，1例因新生血管性青光眼。在36个月随访时（包括接受眼球摘除术的患者）的视力评估显示，38%的眼睛视力下降了3行或更多，77%的眼睛视力为20/200或更好。
¹⁰³Pd敷贴放射治疗可用于治疗葡萄膜黑色素瘤。与¹²⁵I相比，计算机剂量测定表明¹⁰³Pd的剂量分布更有利。大多数患者的治疗导致肿瘤缩小并保留了功能性视力。作者未发现可能妨碍¹⁰³Pd眼内敷贴放射治疗脉络膜黑色素瘤的并发症。
