Kaiserman I, Anteby I, Chowers I, Blumenthal E Z, Kliers I, Pe'er J
Department of Ophthalmology, Hadassah University Hospital, POB 12000, IL-91120 Jerusalem, Israel.
Br J Ophthalmol. 2004 Jul;88(7):892-5. doi: 10.1136/bjo.2003.036285.
To confirm the prognostic value of post-brachytherapy initial tumour regression rate in posterior uveal melanoma.
A prospective, comparative, observational cohort study was carried out on 147 eyes (147 patients) with choroidal melanoma (mean age 61 years) treated with Ru-106 brachytherapy.
Patients were followed clinically and ultrasonically every 6.7 (SD 0.3) months (1001 examinations). On average each patient was examined 5.8 times (mean follow up 9.6 (3.7) years). The echographic parameters included tumour base size, height, internal reflectivity, regularity, vascularity, and extrascleral extension. The clinical follow up included ocular examination and periodic metastatic screening (liver function tests and liver imaging). Main outcome measures were risk of liver metastasis in correlation with the post-brachytherapy initial tumour regression rate.
At brachytherapy the mean tumour height was 5.2 mm (range 2.2-11.8 mm). After brachytherapy 142 tumours (96.6%) responded by a decrease in height. The initial height regression rate was 6.1% (0.8%) per month in patients who later developed metastasis v 4.3% (0.4%) per month in those who did not. Tumours higher than 6 mm, tumours with an internal reflectivity smaller than 50%, and tumours with an initial rate of height regression larger than 0.7 mm/month (10% per month) had higher 5 year melanoma related mortality. Kaplan-Meier survival analysis and the multivariate Cox proportional hazards model showed a significant role for tumour height and initial tumour regression rate on patients' survival.
This study confirms that post-brachytherapy initial tumour regression rate has a prognostic value.
证实近距离放疗后初始肿瘤消退率对后葡萄膜黑色素瘤的预后价值。
对147例（147只眼）脉络膜黑色素瘤患者（平均年龄61岁）进行了一项前瞻性、对比性、观察性队列研究，这些患者均接受了钌-106近距离放疗。
每6.7（标准差0.3）个月对患者进行临床和超声随访（共1001次检查）。平均每位患者接受5.8次检查（平均随访9.6（3.7）年）。超声检查参数包括肿瘤基底大小、高度、内部回声、规则性、血管情况和巩膜外扩展情况。临床随访包括眼部检查和定期转移筛查（肝功能检查和肝脏成像）。主要观察指标是与近距离放疗后初始肿瘤消退率相关的肝转移风险。
近距离放疗时肿瘤平均高度为5.2毫米（范围2.2 - 11.8毫米）。近距离放疗后，142个肿瘤（96.6%）高度降低。后来发生转移的患者初始高度消退率为每月6.1%（0.8%），未发生转移的患者为每月4.3%（0.4%）。高度大于6毫米的肿瘤、内部回声小于50%的肿瘤以及初始高度消退率大于0.7毫米/月（每月10%）的肿瘤，其5年黑色素瘤相关死亡率更高。Kaplan-Meier生存分析和多变量Cox比例风险模型显示肿瘤高度和初始肿瘤消退率对患者生存有显著影响。
本研究证实近距离放疗后初始肿瘤消退率具有预后价值。
