Lumbroso L, Desjardins L, Levy C, Plancher C, Frau E, D'Hermies F, Schlienger P, Mammar H, Delacroix S, Nauraye C, Ferrand R, Desblancs C, Mazal A, Asselain B
Department of Ophthalmology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France.
Br J Ophthalmol. 2001 Nov;85(11):1305-8. doi: 10.1136/bjo.85.11.1305.
To describe the inflammatory reaction that can occur following proton beam irradiation of uveal melanomas based on a large series of patients and to try to determine the risk factors for this reaction.
Data from a cohort of patients with uveal melanoma treated by proton beam irradiation between 1991 and 1994 were analysed. The presence of inflammation was recorded and evaluated. Kaplan-Meier estimates and statistical analysis of general and tumour related risk factors were performed.
28% of patients treated during this period presented with ocular inflammation (median follow up 62 months). Risks factors were essentially tumour related and were correlated with larger lesions (height > 5 mm, diameter > 12 mm, volume > 0.4 cm(3)). Multivariate analysis identified initial tumour height and irradiation of a large volume of the eye as the two most important risk factors. Ocular inflammation usually consisted of mild anterior uveitis, resolving rapidly after topical steroids and cycloplegics. The incidence of inflammation after proton beam irradiation of melanomas seems higher than previously reported and is related to larger lesions. Evidence of inflammation associated with uveal melanoma has been described and seems to be associated with tumour necrosis (spontaneous or after irradiation). The appearance of transient inflammation during the follow up of these patients may be related to the release of inflammatory cytokines during tumour necrosis.
Inflammation following proton beam irradiation is not unusual. It is correlated with larger initial tumours and may be related to tumour necrosis.
基于大量患者描述葡萄膜黑色素瘤质子束照射后可能发生的炎症反应，并试图确定该反应的危险因素。
分析1991年至1994年间接受质子束照射治疗的葡萄膜黑色素瘤患者队列的数据。记录并评估炎症的存在情况。对一般和肿瘤相关危险因素进行Kaplan-Meier估计和统计分析。
在此期间接受治疗的患者中有28%出现眼部炎症（中位随访62个月）。危险因素主要与肿瘤相关，且与较大的病变相关（高度>5mm、直径>12mm、体积>0.4cm³）。多变量分析确定初始肿瘤高度和眼内大体积照射为两个最重要的危险因素。眼部炎症通常表现为轻度前葡萄膜炎，局部使用类固醇和睫状肌麻痹剂后迅速消退。黑色素瘤质子束照射后炎症的发生率似乎高于先前报道，且与较大病变有关。已描述了与葡萄膜黑色素瘤相关的炎症证据，似乎与肿瘤坏死（自发或照射后）有关。这些患者随访期间短暂炎症的出现可能与肿瘤坏死期间炎性细胞因子的释放有关。
质子束照射后的炎症并不罕见。它与初始较大肿瘤相关，可能与肿瘤坏死有关。
