The New York Eye Cancer Center, New York, New York; The New York Eye and Ear Infirmary, New York, NY 10065, USA. pfinger@eyecancer
Am J Ophthalmol. 2010 Apr;149(4):608-15. doi: 10.1016/j.ajo.2009.11.006. Epub 2010 Feb 6.
To determine how tumor characteristics and radiation dose affect the incidence of radiation maculopathy (RM).
Retrospective, consecutive case series.
A consecutive case series of 384 uveal melanomas irradiated (mean apical dose, 71.2 Gy) were followed up for a mean 47.2 months. Tumor locations included: 122 (32%) centered anterior to the equator, 27 (7%) equatorial, and 235 (61%) posterior. Tumor sizes were American Joint Committee on Cancer class T1 (n = 180), T2 (n = 150), T3 (n = 47), and T4 (n = 7).
RM occurred in 8 (7%) eyes with anterior uveal melanomas. In contrast, it was found in 82 (41%) eyes with posterior tumors. Multivariate analysis revealed the risk related to posterior location was greater compared with anterior location with a hazard ratio of 6.66 (95% confidence interval [CI], 4.94 to 22.50; P = .0001). Tumor height (> 6.0 mm) also demonstrated a high risk for RM (hazard ratio, 4.5; 95% CI, 2.68 to 10.17; P = .0001). A significant dose-response relationship was found between dose to fovea and RM (P = .0005, for trend). As compared with a dose of < 35 Gy, the risk of RM was 1.74 (95% CI, 0.98 to 3.1) for doses from 35 to 70 Gy, and the risk of RM was 2.43 (95% CI, 1.48 to 4.0) for doses of 70 Gy or more. Of interest, those anterior melanomas with RM had a mean apical height of 9.4 mm, as compared with a mean height of 3.3 mm for anterior tumors not associated with RM. Visual acuity was preserved if the fovea dose was less than 35 Gy.
This study suggests that tumor location, tumor thickness, and radiation dose to the fovea are risk factors for the development of RM.
确定肿瘤特征和辐射剂量如何影响放射性黄斑病变（RM）的发生率。
回顾性、连续病例系列。
对连续的 384 例葡萄膜黑色素瘤进行了照射（平均顶剂量为 71.2Gy），平均随访 47.2 个月。肿瘤位置包括：122 例（32%）位于赤道前，27 例（7%）位于赤道，235 例（61%）位于赤道后。肿瘤大小为美国癌症联合委员会（AJCC）T1 期（n=180）、T2 期（n=150）、T3 期（n=47）和 T4 期（n=7）。
8 只（7%）前葡萄膜黑色素瘤眼发生 RM。相比之下，82 只（41%）后葡萄膜黑色素瘤眼发生 RM。多变量分析显示，与前位相比，后位的风险更大，危险比为 6.66（95%置信区间[CI]，4.94 至 22.50；P=0.0001）。肿瘤高度（>6.0mm）也显示出 RM 的高风险（危险比，4.5；95%CI，2.68 至 10.17；P=0.0001）。在 fovea 剂量与 RM 之间发现了显著的剂量反应关系（P=0.0005，趋势）。与<35Gy 的剂量相比，35-70Gy 剂量的 RM 风险为 1.74（95%CI，0.98 至 3.1），70Gy 或更高剂量的 RM 风险为 2.43（95%CI，1.48 至 4.0）。有趣的是，那些有 RM 的前葡萄膜黑色素瘤的顶端高度平均为 9.4mm，而与没有 RM 的前葡萄膜黑色素瘤相比，其平均高度为 3.3mm。如果 fovea 剂量小于 35Gy，则可保留视力。
本研究表明，肿瘤位置、肿瘤厚度和 fovea 辐射剂量是 RM 发展的危险因素。
