Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):844-8. doi: 10.1016/j.ijrobp.2009.08.059. Epub 2010 Feb 19.
The Collaborative Ocular Melanoma Study (COMS) established iodine-125 plaque brachytherapy as an accepted standard treatment for medium-size choroidal melanoma. In the COMS, the prescription dose was 85 Gy. This is a retrospective review of our outcomes in patients treated with lower doses than those used in the COMS.
From 1990 to 2004, 62 patients were treated with iodine-125 plaque brachytherapy for choroidal melanoma. COMS eye plaques were used with dose prescribed to the apex of the tumor. The median and average dose rates at the tumor apex were 63.5 cGy/h and 62.7 cGy/h, respectively. The median and average total doses were 63.0 Gy and 62.5 Gy (range, 56-69 Gy), respectively. The median and mean durations of implant were 100.0 hours and 101.1 hours (range, 71-165 hours).
Median follow-up time was 58.2 months. The 5-year outcomes including overall survival, disease-free survival, cause-specific survival, local failure, secondary enucleation rate, and visual acuity (VA) <20/200 were estimated using the Kaplan-Meier method. Overall, there were 7 local failures, 4 distant failures, and 10 secondary enucleations (6 due to local failure and 4 due to treatment complications). Univariate analysis was performed to identify significant prognostic factors associated with disease-free survival (baseline VA in tumor eye, tumor shape), cause-specific survival (diabetic retinopathy), local failure (none found), secondary enucleation rate (diabetic retinopathy, basal tumor dimension) and VA <20/200 (diabetic retinopathy, tumor shape, age, retinal detachment, treatment depth, and history of vision-limiting condition).
Our survival and local control outcomes are comparable to those of the COMS. However, VA at 5 years seems to be better. Lower doses of radiation could potentially lead to better visual outcomes.
COMS 协作眼黑色素瘤研究确立了碘-125 放射性粒子近距离治疗作为中大型脉络膜黑色素瘤的标准治疗方法。在 COMS 中，处方剂量为 85Gy。本研究回顾性分析了我们采用低于 COMS 治疗剂量的患者的治疗结果。
1990 年至 2004 年，62 例脉络膜黑色素瘤患者接受碘-125 放射性粒子近距离治疗。采用 COMS 眼用放射性粒子敷贴器，处方剂量设定在肿瘤顶点。肿瘤顶点的中位和平均剂量率分别为 63.5cGy/h 和 62.7cGy/h。中位和平均总剂量分别为 63.0Gy 和 62.5Gy（范围为 56-69Gy）。植入的中位和平均时间分别为 100.0 小时和 101.1 小时（范围为 71-165 小时）。
中位随访时间为 58.2 个月。采用 Kaplan-Meier 方法估计 5 年总生存率、无瘤生存率、肿瘤特异性生存率、局部失败率、二次眼球摘除率和视力（VA）<20/200 的情况。共有 7 例局部失败，4 例远处失败和 10 例二次眼球摘除（6 例因局部失败，4 例因治疗并发症）。进行单变量分析以确定与无瘤生存率（肿瘤眼的基线 VA、肿瘤形状）、肿瘤特异性生存率（糖尿病性视网膜病变）、局部失败率（未发现）、二次眼球摘除率（糖尿病性视网膜病变、基底肿瘤尺寸）和 VA<20/200（糖尿病性视网膜病变、肿瘤形状、年龄、视网膜脱离、治疗深度和视力受限病史）相关的显著预后因素。
我们的生存率和局部控制结果与 COMS 相似。然而，5 年时的 VA 似乎更好。较低的辐射剂量可能会带来更好的视力结果。
