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海报“伽玛刀放射外科与¹²⁵I敷贴近距离放射治疗脉络膜黑色素瘤队列的剂量学比较”综述

Review of the poster "Dosimetric comparison of gamma knife radiosurgery vs. 125I plaque brachytherapy in a cohort of choroidal melanomas".

作者信息

Odell Kelly R

机构信息

Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.

出版信息

Med Dosim. 2009 Summer;34(2):107-9. doi: 10.1016/j.meddos.2008.05.002. Epub 2008 Jun 10.

Abstract

Historically, treatment for choroidal melanomas was surgical enucleation. Currently, treatment methods such as stereotactic radiosurgery and brachytherapy are being used to spare the eye. The poster "Dosimetric Comparison of Gamma Knife Radiosurgery vs. I-125 Plaque Brachytherapy in a Cohort of Choroidal Melanomas" presented at ASTRO 2007 by Anderson et al. provides a comparison of these methods. The dose to disk, fovea and lens in 29 patients from a simulated I-125 treatment and a delivered Gamma Knife radiosurgery was compared. Thirty Gy was prescribed to the 50% Isodose line in the radiosurgery and 85 Gy was prescribed to the apex of the tumor in the I-125 simulation. It was found that the Gamma Knife spares the disk better in 59% of the tumors, including those >or=6.5 mm in height; spares the fovea better in 69% of the tumors, including those >or=5.5 mm; and spares lens better in only 30% of the tumors, with no distinction in size. Tumor location was not taken into account for this study, which could explain the variations in smaller tumors. For larger tumors, gamma knife will protect most organs at risk more effectively. This study shows how a tumor's parameters can be used in selecting treatment modality.

摘要

从历史上看,脉络膜黑色素瘤的治疗方法是手术摘除眼球。目前,立体定向放射外科和近距离放射治疗等治疗方法正在被用于保住眼球。安德森等人在2007年美国放射肿瘤学会年会上展示的海报“脉络膜黑色素瘤队列中伽玛刀放射外科与碘-125敷贴器近距离放射治疗的剂量学比较”对这些方法进行了比较。对29例患者模拟碘-125治疗和实际伽玛刀放射外科治疗时视盘、黄斑和晶状体所接受的剂量进行了比较。放射外科治疗中,规定50%等剂量线的剂量为30 Gy,碘-125模拟治疗中规定肿瘤顶点的剂量为85 Gy。结果发现,伽玛刀在59%的肿瘤中对视盘的保护更好,包括高度≥6.5 mm的肿瘤;在69%的肿瘤中对黄斑的保护更好,包括直径≥5.5 mm的肿瘤;而在仅30%的肿瘤中对晶状体的保护更好,且与肿瘤大小无关。本研究未考虑肿瘤位置,这可能解释了较小肿瘤中的差异。对于较大肿瘤,伽玛刀能更有效地保护大多数危及器官。这项研究展示了如何利用肿瘤参数来选择治疗方式。

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