Lumbroso L, Levy C, Plancher C, Frau E, D'hermies F, Schlienger P, Dendale R, Mammar H, Delacroix S, Nauraye C, Noel G, Ferrand R, Desblancs C, Mazal A, Validire P, Asselain B, Desjardins L
Service d'Ophtalmologie, Institut Curie, 26 rue d'Ulm, 75231, Paris Cedex 05.
J Fr Ophtalmol. 2002 Mar;25(3):290-7.
To evaluate the results of proton beam irradiation of choroidal melanomas on a large series of patients.
Retrospective analysis of a series of patients treated with proton beam irradiation between 1991 and December 1998. The data were analyzed to evaluate the local tumor control as well as the general progression and metastatic rate of the patients. Statistical analysis served to isolate risk factors for relapse or metastasis.
We treated 1062 patients during the study period, with a median follow-up of 38 months. Local control was obtained for 97.1% of the patients. Tumors anterior to the equator were at risk for relapse. The survival rate was 92% at 2 years and 78% at 5 years. 73.1% of the 1062 patients died from metastasis, 6.1% of living patients presented with metastatic disease. The risk factors for death were the initial diameter, the age of the patient, and large tumor volume at diagnosis. Metastasis were essentially hepatic (94.6%). Risk factors for metastasis were: a large tumor volume, a lesion anterior or straddling the equator and the age of the patient. Ocular complications may induce a visual loss of 0.1 and less in 47% of the patients, due to optic nerve head and macular ischemia. 6% of the patients required secondary enucleation due to local complications (neovascular glaucoma).
Proton beam irradiation of choroidal melanoma allows good tumor control and eye retention. The survival prognosis is associated with the initial volume of the tumor. The functional results may be improved and new therapeutics are needed to treat metastatic disease.
评估对大量脉络膜黑色素瘤患者进行质子束照射的结果。
对1991年至1998年12月间接受质子束照射治疗的一系列患者进行回顾性分析。分析数据以评估局部肿瘤控制情况以及患者的总体进展和转移率。统计分析用于确定复发或转移的危险因素。
在研究期间，我们共治疗了1062例患者，中位随访时间为38个月。97.1%的患者实现了局部控制。赤道前方的肿瘤有复发风险。2年生存率为92%，5年生存率为78%。1062例患者中有73.1%死于转移，6.1%的存活患者出现转移性疾病。死亡的危险因素为初始直径、患者年龄以及诊断时肿瘤体积较大。转移主要发生在肝脏（94.6%）。转移的危险因素为：肿瘤体积大、病变位于赤道前方或跨越赤道以及患者年龄。眼部并发症可能导致47%的患者视力丧失0.1及以下，原因是视神经乳头和黄斑缺血。6%的患者因局部并发症（新生血管性青光眼）需要进行二次眼球摘除术。
质子束照射脉络膜黑色素瘤可实现良好的肿瘤控制并保留眼球。生存预后与肿瘤的初始体积有关。功能结果可能会得到改善，需要新的治疗方法来治疗转移性疾病。
