Nishimura Y, Nakai A, Yoshimasu T, Yagyu Y, Nakamatsu K, Shindo H, Ishida O
Department of Radiology, Kinki University School of Medicine, Osaka-Sayama, Japan.
Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):137-41. doi: 10.1016/s0360-3016(99)00419-8.
The long-term safety and effectiveness of fractionated strontium-90 radiation therapy (RT) for pterygium were reviewed retrospectively.
Between 1984 and 1996, 399 patients with 490 pterygia were treated with a strontium-90 eye applicator following surgical removal of the pterygium. The median follow-up period was 61 months (range 2-178). Of the 490 pterygia, 452 were fresh, 17 were recurrences after surgical removal alone, and 21 were recurrences after surgical removal plus postoperative RT. Fractionated RT of 31-42 Gy/4-5 fractions/22-29 days was given for 95.1% of the pterygia.
In total, 58 (11.8%) local recurrences of pterygia were noted. The median time of local recurrences was 10 months, ranging from 2 to 93 months, and 16 recurrences (28%) were noted later than 24 months after treatment. The interval between surgery and the start of RT (1-3 days vs. >3 days) and recurrent pterygia were significant variables for local control in the multivariate analysis, while total RT dose (7-29 Gy vs. 31-50 Gy) was a marginally significant variable. Late toxicities that may be associated with strontium-90 RT were scleromalacia (scleral thinning) in 4 eyes, adhesion of eyelids in 3 eyes, and scleral ulcer in 2 eyes.
Fractionated strontium-90 RT of approximately 40 Gy/4-5 fractions was safe and effective for preventing recurrence of pterygia, when RT was started within 3 days of surgery.
回顾性分析分次90锶放射治疗（RT）翼状胬肉的长期安全性和有效性。
1984年至1996年间，490例翼状胬肉患者在手术切除翼状胬肉后接受了90锶眼部敷贴器治疗，共399例。中位随访期为61个月（范围2 - 178个月）。490例翼状胬肉中，452例为初发，17例为单纯手术切除后复发，21例为手术切除加术后放疗后复发。95.1%的翼状胬肉接受了31 - 42 Gy/4 - 5次/22 - 29天的分次放疗。
共发现58例（11.8%）翼状胬肉局部复发。局部复发的中位时间为10个月，范围为2至93个月，16例复发（28%）发生在治疗后24个月以后。多因素分析显示，手术与放疗开始的间隔时间（1 - 3天与>3天）和复发性翼状胬肉是局部控制的显著变量因素，而总放疗剂量（7 - 29 Gy与31 - 50 Gy）是边缘显著变量因素。可能与90锶放疗相关的晚期毒性反应包括4只眼的巩膜软化（巩膜变薄）、3只眼的眼睑粘连和2只眼的巩膜溃疡。
当在手术3天内开始放疗时，约40 Gy/4 - 5次的分次90锶放疗对预防翼状胬肉复发是安全有效的。
