Bellmann C, Fuss M, Holz F G, Debus J, Rohrschneider K, Völcker H E, Wannenmacher M
Department of Ophthalmology, University of Heidelberg, Germany.
Ophthalmology. 2000 Feb;107(2):358-65. doi: 10.1016/s0161-6420(99)00081-0.
To evaluate the role of stereotactic radiation therapy (SRT) in the treatment of malignant choroidal tumors.
Prospective, noncomparative case series.
Ten patients with unifocal choroidal metastasis (three lung carcinoma, three breast carcinoma, three colon carcinoma, one cutaneous melanoma) and five patients with primary choroidal melanoma underwent single-dose or fractionated SRT.
Before treatment, computed tomography (CT) scans of the orbit were obtained with the patient wearing an individualized immobilization mask. An integrated macro-CCD-camera system viewed the eye for detection of movements. Three-dimensional computer-based treatment planning was carried out. Dose distribution was calculated and displayed in isodose lines on the CT data set. For SRT, a dedicated stereotactic linear accelerator (6 MV) was used. Total doses for choroidal metastases were 12 to 20 Gy in a single dose or 30 Gy over 10 days (3 Gy each session), and total doses for choroidal melanoma were 50 Gy over 5 or 10 days (10 or 5 Gy each session).
Best corrected visual acuity (ETDRS-chart), biomicroscopy, ultrasound examination, fluorescein angiography, and magnetic resonance imaging (MRI) were performed before treatment and at regular intervals after completion of SRT.
During a follow-up period from 1 to 34 months (median, 6.5 months), local tumor control was achieved in all eyes. A decrease in tumor size on ultrasonography or MRI was noted in eight patients. No persistent side effects were observed during follow-up.
Stereotactic radiation therapy allows steep dose gradients outside the target volume by minimizing the field of exposure. Thus only low radiation doses affect surrounding radiosensitive ocular structures. Our initial findings suggest that this technique may be effective in controlling tumor growth. Further studies are needed to compare treatment efficacy and safety with conventional treatment methods.
评估立体定向放射治疗（SRT）在恶性脉络膜肿瘤治疗中的作用。
前瞻性、非对照病例系列。
10例单灶性脉络膜转移瘤患者（3例肺癌、3例乳腺癌、3例结肠癌、1例皮肤黑色素瘤）和5例原发性脉络膜黑色素瘤患者接受了单次或分次SRT。
治疗前，患者佩戴个体化固定面罩进行眼眶计算机断层扫描（CT）。使用集成的大尺寸电荷耦合器件（macro-CCD）相机系统观察眼睛以检测运动。进行基于计算机的三维治疗计划。计算剂量分布并在CT数据集上以等剂量线显示。对于SRT，使用专用的立体定向直线加速器（6兆伏）。脉络膜转移瘤的总剂量为单次12至20戈瑞或10天内30戈瑞（每次3戈瑞），脉络膜黑色素瘤的总剂量为5或10天内50戈瑞（每次10或5戈瑞）。
在治疗前以及SRT完成后的定期时间点进行最佳矫正视力（ETDRS视力表）、生物显微镜检查、超声检查、荧光素血管造影和磁共振成像（MRI）。
在1至34个月的随访期内（中位时间为6.5个月），所有患眼均实现了局部肿瘤控制。8例患者超声或MRI检查显示肿瘤大小减小。随访期间未观察到持续的副作用。
立体定向放射治疗通过最小化照射野，在靶体积外形成陡峭剂量梯度。因此，只有低辐射剂量影响周围放射敏感的眼部结构。我们的初步研究结果表明，该技术可能有效控制肿瘤生长。需要进一步研究以比较其与传统治疗方法的疗效和安全性。
