Willner J, Flentje M, Lieb W
Department of Radiation Therapy, University of Würzburg, Germany.
Strahlenther Onkol. 2001 Aug;177(8):404-9. doi: 10.1007/pl00002422.
Analysis of effectiveness of perioperative 20 kV soft X-ray irradiation in recurrent pterygium as an alternative to postoperative 90Sr beta irradiation.
Between 1987 and 2000 a total of 65 patients with 81 pterygia were treated with 20 kV X-ray therapy in the course of surgical treatment of recurrent pterygium. Until 1995 simple excision (bare sclera technique) followed by postoperative irradiation (generally four fractions of 5 Gy) was applied, with radiation starting on mean 4 days following surgery (34 cases, mean follow-up 52 months). Since 1995 we have changed our policy to a perioperative regimen starting with a single dose of 7 Gy prior to microsurgical excision with conjunctival autograft and proceeding within 24 hours with 5 Gy single dose to the surgical bed and then every other day to a total dose of 27 Gy (47 cases, mean follow-up 31 months). Recurrence rate was calculated by Kaplan Meier method. A multivariate Cox regression analysis of prognostic factors for recurrence was performed.
A total of 19 recurrences were observed, 15 in the historical postoperative group and four in the perioperative group. Actuarial 2- and 5-year recurrence rate is 9% in the "new treatment group" compared to 34% and 56% in the historical group (p = 0.001). Only one of the four recurrences among the pre- and postoperatively irradiated group required a new surgical procedure. In this case radiation had been terminated at 17 Gy. Actuarial rate of surgical reintervention was only 2% at 2 and 5 years compared to 28% and 36% in the historical group. In multivariate Cox regression analysis only the new treatment strategy was found to influence control rate significantly. Until now no case of severe side effects like scleral necrosis or thinning, symble-pharon, radiation-induced cataract or glaucoma were observed in both groups.
The combination of pre- and postoperative 20 kV X-ray therapy and microsurgical excision combined with conjunctival autograft is a highly effective treatment to prevent recurrence in the high-risk group of recurrent pterygia and can be recommended as an alternative to postoperative 90Sr beta irradiation.
分析围手术期20 kV软X线照射治疗复发性翼状胬肉的有效性，作为术后90Srβ射线照射的替代方法。
1987年至2000年间，共有65例患有81只翼状胬肉的患者在复发性翼状胬肉的手术治疗过程中接受了20 kV X线治疗。1995年以前，采用单纯切除（裸巩膜技术）并术后照射（通常为4次，每次5 Gy），放疗平均在术后4天开始（34例，平均随访52个月）。自1995年以来，我们改变策略，采用围手术期方案，在显微手术切除联合结膜自体移植术前先给予单剂量7 Gy照射，然后在24小时内对手术床给予单剂量5 Gy照射，之后每隔一天照射一次，直至总剂量达到27 Gy（47例，平均随访31个月）。复发率采用Kaplan-Meier法计算。对复发的预后因素进行多因素Cox回归分析。
共观察到19例复发，其中15例在历史术后组，4例在围手术期组。“新治疗组”的2年和5年精算复发率为9%，而历史组分别为34%和56%（p = 0.001）。术前和术后照射组的4例复发中只有1例需要再次手术。在该病例中，放疗在17 Gy时终止。2年和5年再次手术的精算率仅为2%，而历史组分别为28%和36%。在多因素Cox回归分析中，仅发现新的治疗策略对控制率有显著影响。到目前为止，两组均未观察到巩膜坏死或变薄、睑球粘连、放射性白内障或青光眼等严重副作用的病例。
术前和术后20 kV X线治疗联合显微手术切除联合结膜自体移植是预防复发性翼状胬肉高危组复发的高效治疗方法，可推荐作为术后90Srβ射线照射的替代方法。
