Tabandeh H, Chaudhry N A, Murray T G, Ehlies F, Hughes R, Scott I U, Markoe A M
Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami School of Medicine, Florida 33101, USA.
Am J Ophthalmol. 2000 Feb;129(2):199-204. doi: 10.1016/s0002-9394(99)00315-3.
To report intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma.
In a retrospective study, 117 eyes with medium-sized choroidal melanoma in 117 patients not participating in the Collaborative Ocular Melanoma Study underwent iodine-125 episcleral plaque radiotherapy with intraoperative echographic verification of plaque placement between January 1992 and December 1998 at the Bascom Palmer Eye Institute.
After initial plaque placement using standard localization techniques, intraoperative echography demonstrated satisfactory tumor-plaque apposition in 76% of eyes (89 of 117). In the 28 eyes (28 of 117, 24%) that required repositioning of the plaque, the extent of misplacement was less than 1 mm in 10 eyes, 1.1 to 3.0 mm in six eyes, and greater than 3 mm in eight eyes. Two eyes had tilting of the plaque, and in two additional eyes, although the plaque covered all tumor margins, the centration was considered suboptimal. Repositioning was necessary in 1 eye with an anteriorly located tumor (1 of 13, 7.7%) and in 20 eyes with peripapillary or posterior pole tumors (20 of 67, 26.3%). Anteriorly located tumors required plaque repositioning significantly less frequently than did posteriorly located tumors (P = .041). Misalignment involved one tumor margin in 23 eyes and two margins in five eyes. The most commonly misaligned margins were the lateral (35%) and posterior margins (26%). In no case was an anterior marginal misalignment documented. At a mean follow-up of 37 months, no tumor-related death or metastatic disease was noted. Two of the 117 patients (1.7%) had local tumor recurrence and underwent enucleation.
Intraoperative echography is an effective adjunct for localization and confirmation of tumor-plaque relationship. This technique facilitates the identification and correction of suboptimal plaque placement at the time of surgery, potentially minimizing treatment failures.
报告用于脉络膜黑色素瘤近距离放射治疗的碘 - 125巩膜外斑块的术中超声定位。
在一项回顾性研究中，1992年1月至1998年12月期间，117例未参与协作性眼黑色素瘤研究的患者的117眼中等大小脉络膜黑色素瘤接受了碘 - 125巩膜外斑块放射治疗，并在Bascom Palmer眼科研究所进行了术中超声检查以验证斑块放置情况。
使用标准定位技术初步放置斑块后，术中超声显示76%的眼（117眼中的89眼）肿瘤与斑块贴合良好。在需要重新放置斑块的28眼（117眼中的28眼，24%）中，10眼的错位程度小于1毫米，6眼为1.1至3.0毫米，8眼大于3毫米。2眼斑块发生倾斜，另外2眼中，尽管斑块覆盖了所有肿瘤边缘，但中心定位被认为欠佳。1眼位于前部的肿瘤（13眼中的1眼，7.7%）和20眼视乳头周围或后极部肿瘤（67眼中的20眼，26.3%）需要重新定位。前部肿瘤比后部肿瘤需要斑块重新定位的频率显著更低（P = 0.041）。23眼的错位涉及一个肿瘤边缘，5眼涉及两个边缘。最常错位的边缘是外侧边缘（35%）和后边缘（26%）。未记录到前边缘错位的情况。平均随访37个月时，未观察到与肿瘤相关的死亡或转移性疾病。117例患者中有2例（1.7%）发生局部肿瘤复发并接受了眼球摘除术。
术中超声是定位和确认肿瘤与斑块关系的有效辅助手段。该技术有助于在手术时识别和纠正欠佳的斑块放置情况，可能使治疗失败最小化。
