Sagoo Mandeep S, Shields Carol L, Mashayekhi Arman, Freire Jorge, Emrich Jacqueline, Reiff Jay, Komarnicky Lydia, Shields Jerry A
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Arch Ophthalmol. 2007 Sep;125(9):1202-9. doi: 10.1001/archopht.125.9.1202.
To report results of plaque radiotherapy for choroidal melanoma that completely encircles the optic disc (circumpapillary melanoma).
Retrospective medical record review over a 31-year period of 37 consecutive patients. The main outcome measures were treatment complications, long-term visual acuity, enucleation, tumor recurrence, metastasis, and death.
The median patient age at treatment was 69 years (range, 20-86 years). The presenting complaint was visual loss in 19 eyes (51%), photopsia in 5 (14%), and visual field loss in 3 (8%). All tumors touched and encircled the optic disc for 360 degrees . The quadrantic location of the main tumor epicenter was superior in 8 eyes (22%), nasal in 10 (27%), inferior in 9 (24%), and temporal in 10 (27%). The median tumor basal diameter was 11 mm (range, 4.8-20 mm) and median tumor thickness was 3.6 mm (range, 1.8-14.8 mm). The optic disc was obscured to some extent by overhanging tumor in 19 cases (52%). The most commonly used isotope for plaque radiotherapy was iodine 125 (n = 34 cases; 92%), and a notched plaque design was used in 34 cases (92%). Planned adjunctive treatment included transpupillary thermotherapy in 17 cases (49%) and argon laser photocoagulation in 6 of 35 cases (17%) with follow-up. Of the 28 eyes with more than 5 months' follow-up (mean, 52 months; median, 46 months; range, 5-234 months), treatment complications included nonproliferative and proliferative retinopathy in 11 (39%) and 7 eyes (25%); maculopathy in 7 (25%); papillopathy in 9 eyes (32%); neovascular glaucoma in 5 (18%); and vitreous hemorrhage in 13 (46%). Pars plana vitrectomy was required in only 2 of 13 eyes (15%) with persistent vitreous hemorrhage. Long-term visual acuity of 20/200 or worse was observed in 13 eyes (62%), and 12 eyes (57%) lost more than 5 Snellen visual acuity lines, excluding 7 cases (25%) in which enucleation was necessary. Recurrence was noted in 4 cases (14%), of which 3 were treated with enucleation and 1 with transpupillary thermotherapy. Systemic metastasis occurred in 1 patient (4%) and there were no melanoma-specific deaths during the study period.
Custom-designed plaque radiotherapy is a potential treatment for selected patients with circumpapillary choroidal melanoma. We found satisfactory local tumor control, and globe retention was achieved in 75% of eyes with more than 5 months' follow-up.
报告对完全环绕视盘的脉络膜黑色素瘤（视盘周围黑色素瘤）进行敷贴放射治疗的结果。
对37例连续患者进行为期31年的回顾性病历审查。主要观察指标为治疗并发症、长期视力、眼球摘除、肿瘤复发、转移和死亡。
治疗时患者的中位年龄为69岁（范围20 - 86岁）。主要症状为19只眼（51%）视力丧失，5只眼（14%）有闪光感，3只眼（8%）有视野缺损。所有肿瘤均接触并环绕视盘360度。主要肿瘤中心的象限位置：上方8只眼（22%），鼻侧10只眼（27%），下方9只眼（24%），颞侧10只眼（27%）。肿瘤基底直径中位数为11毫米（范围4.8 - 20毫米），肿瘤厚度中位数为3.6毫米（范围1.8 - 14.8毫米）。19例（52%）视盘因肿瘤悬垂而有不同程度遮挡。敷贴放射治疗最常用的同位素是碘125（34例；92%），34例（92%）采用带缺口的敷贴设计。计划的辅助治疗包括17例（49%）行经瞳孔温热疗法，35例中有6例（17%）在随访时行氩激光光凝。在28只随访超过5个月的眼中（平均随访52个月；中位数46个月；范围5 - 234个月），治疗并发症包括11只眼（39%）发生非增殖性和增殖性视网膜病变，7只眼（25%）发生黄斑病变，9只眼（32%）发生视乳头病变，5只眼（18%）发生新生血管性青光眼，13只眼（46%）发生玻璃体积血。13只持续玻璃体积血的眼中仅2只（15%）需要行玻璃体切割术。13只眼（62%）长期视力为20/200或更差，12只眼（57%）视力下降超过5行Snellen视力表，7例（25%）因必要而行眼球摘除术未计入。4例（14%）出现复发，其中3例行眼球摘除术，1例行经瞳孔温热疗法。1例患者（4%）发生全身转移，研究期间无黑色素瘤特异性死亡病例。
定制的敷贴放射治疗是部分视盘周围脉络膜黑色素瘤患者的一种潜在治疗方法。我们发现局部肿瘤控制效果良好，随访超过5个月的眼中75%实现了眼球保留。
