Shields Carol L, Naseripour Masood, Shields Jerry A, Freire Jorge, Cater Jacqueline
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2003 May;135(5):648-56. doi: 10.1016/s0002-9394(02)02241-9.
To evaluate plaque radiotherapy for iris melanoma.
Prospective noncomparative interventional case series.
For 38 patients, custom-designed plaque radiotherapy using iodine 125 isotope was applied overlying the cornea with a tumor apex dose of 80 Gy. The main outcome measures were tumor control and ocular complications using Kaplan-Meier estimates and Cox proportional hazards regression analysis.
In all cases, the melanoma was nonresectable owing to large or discohesive tumor. The tumor configuration was nodular in 24 cases (63%) and flat (diffuse) in 14 (37%). The mean tumor basal diameter was 9 mm (range 4 to 13 mm). Solid tumor extended into the anterior chamber angle in 36 eyes (95%). Tumor seeds were noted on the iris stroma for a mean of 7 clock hours and in the anterior chamber angle for a mean of 4 clock hours. Five-year follow up revealed tumor metastasis in 0% and tumor recurrence in 8% of patients. Visual acuity of 20/200 or worse was found in 16% at 5 years. Radiation-related complications at 5 years included corneal epitheliopathy (9%), cataract (70%), and neovascular glaucoma (8%). No patients developed corneal necrosis, scleral necrosis, retinopathy, or papillopathy. After treatment, the combined incidence of tumor-related and radiation-related elevated intraocular pressure at 5 years was 33%. Enucleation was necessary in 13% at 5 years, for tumor recurrence (n = 3) and patient preference (n = 1).
Plaque radiotherapy is a useful alternative to enucleation for eyes with nonresectable iris melanoma. Tumor control is 92% at 5 years, but related complications, especially cataract and elevated intraocular pressure, should be anticipated.
评估虹膜黑色素瘤的斑块放射治疗。
前瞻性非对比性介入病例系列。
对38例患者，采用定制设计的碘125同位素斑块放射治疗，敷贴于角膜上，肿瘤顶点剂量为80 Gy。主要观察指标为使用Kaplan-Meier估计法和Cox比例风险回归分析的肿瘤控制情况和眼部并发症。
在所有病例中，黑色素瘤因肿瘤大或不粘连而无法切除。肿瘤形态为结节状的有24例（63%），扁平（弥漫性）的有14例（37%）。肿瘤基底平均直径为9 mm（范围4至13 mm）。实体瘤延伸至前房角的有36只眼（95%）。虹膜基质上平均可见7个钟点的肿瘤籽，前房角平均可见4个钟点的肿瘤籽。5年随访显示，患者的肿瘤转移率为0%，肿瘤复发率为8%。5年时视力为20/200或更差的患者占16%。5年时与放射相关的并发症包括角膜上皮病变（9%）、白内障（70%）和新生血管性青光眼（8%）。无患者发生角膜坏死、巩膜坏死、视网膜病变或视乳头病变。治疗后，5年时与肿瘤相关和与放射相关的眼压升高的综合发生率为33%。5年时，13%的患者因肿瘤复发（n = 3）和患者意愿（n = 1）而需要摘除眼球。
对于无法切除的虹膜黑色素瘤患者，斑块放射治疗是一种有用的替代眼球摘除术的方法。5年时肿瘤控制率为92%，但应预期到相关并发症，尤其是白内障和眼压升高。
