Shields Carol L, Cater Jacqueline, Shields Jerry A, Chao Aning, Krema Hatem, Materin Miguel, Brady Luther W
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 900 Walnut St, Philadelphia, PA 19107, USA.
Arch Ophthalmol. 2002 Jul;120(7):933-40. doi: 10.1001/archopht.120.7.933.
To evaluate tumor control and treatment complications following plaque radiotherapy combined with transpupillary thermotherapy for choroidal melanoma.
Prospective noncomparative interventional case series.
All patients received treatment for choroidal melanoma using plaque radiotherapy followed by 3 sessions of transpupillary thermotherapy provided at plaque removal and at 4-month intervals.
Two hundred seventy patients with newly diagnosed choroidal melanoma.
The 2 main outcome measures included local tumor recurrence and treatment-related complications. The clinical data regarding patient features, tumor features, radiotherapy and thermotherapy parameters were analyzed for their effect on the 2 main outcomes using Cox proportional hazards regression models.
Prior to treatment, the median base of the tumor was 11 mm (range, 4-21 mm) and the median thickness was 4 mm (range, 2-9 mm). Most tumors were located in the posterior pole with a median proximity of 2 mm to the foveola and 2 mm to the optic disc. The median radiotherapy dose to the tumor apex was 9000 rad. Transpupillary thermotherapy was applied in 3 sessions at 4-month intervals for a median of 700 mW. The tumor decreased in thickness to a median of 2.3 mm by 1 year and 2.1 mm by 2 years' follow-up with stable findings thereafter. Using Kaplan-Meier estimates, tumor recurrence was 2% at 2 years and 3% at 5 years. Risk factors for tumor recurrence included macular location of the tumor epicenter (P =.03), diffuse tumor configuration (P =.005), and tumor margin extending underneath the foveola (P =.001). Using Kaplan-Meier estimates, treatment-related complications at 5 years included maculopathy in 18% of the participants, papillopathy in 38%, macular retinal vascular obstruction in 18%, vitreous hemorrhage in 18%, rhegmatogenous retinal detachment in 2%, cataract in 6%, and neovascular glaucoma in 7%. Enucleation for radiation complications was necessary in 3 cases (1%).
Plaque radiotherapy combined with transpupillary thermotherapy provides excellent local tumor control with only 3% recurrence at 5 years' follow-up.
评估敷贴放射治疗联合经瞳孔温热疗法治疗脉络膜黑色素瘤后的肿瘤控制情况及治疗并发症。
前瞻性非对照干预性病例系列研究。
所有患者均采用敷贴放射治疗脉络膜黑色素瘤，随后在移除敷贴时及之后每隔4个月进行3次经瞳孔温热疗法。
270例新诊断的脉络膜黑色素瘤患者。
2项主要观察指标包括局部肿瘤复发和治疗相关并发症。使用Cox比例风险回归模型分析患者特征、肿瘤特征、放疗和温热疗法参数等临床数据对这2项主要观察指标的影响。
治疗前，肿瘤基底中位数为11 mm（范围4 - 21 mm），厚度中位数为4 mm（范围2 - 9 mm）。大多数肿瘤位于后极部，距中心凹和视盘的中位数距离均为2 mm。肿瘤顶点的放射治疗剂量中位数为9000拉德。经瞳孔温热疗法每隔4个月进行3次，功率中位数为700毫瓦。随访1年时肿瘤厚度降至中位数2.3 mm，2年时降至2.1 mm，此后结果稳定。采用Kaplan-Meier估计法，2年时肿瘤复发率为2%，5年时为3%。肿瘤复发的危险因素包括肿瘤中心位于黄斑区（P = 0.03）、肿瘤呈弥漫性形态（P = 0.005）以及肿瘤边缘延伸至中心凹下方（P = 0.001）。采用Kaplan-Meier估计法，5年时治疗相关并发症包括18%的患者发生黄斑病变、38%发生视乳头病变、18%发生黄斑视网膜血管阻塞、18%发生玻璃体积血、2%发生孔源性视网膜脱离、6%发生白内障以及7%发生新生血管性青光眼。3例（1%）患者因放射并发症需要行眼球摘除术。
敷贴放射治疗联合经瞳孔温热疗法能实现良好的局部肿瘤控制，5年随访时复发率仅为3%。
