Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Ophthalmology. 2011 Feb;118(2):402-7. doi: 10.1016/j.ophtha.2010.06.007. Epub 2010 Sep 1.
To evaluate treatment of juxtapapillary choroidal melanoma with plaque radiotherapy and to investigate the role of supplemental transpupillary thermotherapy (TTT).
Retrospective, comparative case series.
We included 650 consecutive eyes with juxtapapillary choroidal melanoma within 1 mm of the optic disc.
Eyes with juxtapapillary choroidal melanoma receiving plaque radiotherapy over a 31-year period from October 1974 to November 2005 were included in the study. The TTT and no TTT groups were analyzed separately and compared.
Local tumor control, metastasis, and tumor-related mortality.
The median basal tumor diameter was 10 mm (range, 1.5-21) and median thickness was 3.5 mm (range, 0.5-14.8). In 481 eyes (74%), the tumor was directly adjacent to the optic disc and in 169 eyes (26%) the posterior tumor margin was between 0.1 and 1.0 mm from the optic disc. The circumpapillary extent of the tumor was <4 clock-hours in 321 eyes (50%), 4-8 clock-hours in 250 eyes (38%), and >8 clock-hours in 79 eyes (12%). Plaque radiotherapy using iodine-125 in 616 eyes (95%), cobalt-60 in 19 eyes (3%), iridium-192 in 12 eyes (2%), and ruthenium-106 in 3 eyes (<1%) delivered a median radiation dose of 8000 cGy (range, 3600-15 500) to the tumor apex and adjunctive TTT was used in 307 eyes (56%). Kaplan-Meier estimates for tumor recurrence, metastasis, and death were 14%, 11%, and 4% at 5 years and 21%, 24%, and 9% at 10 years, respectively. Eyes treated with additional TTT showed slight (statistically nonsignificant) reduction in recurrence and metastasis. Using multivariable analysis, factors predictive of tumor recurrence included foveolar tumor requiring TTT (hazard ratio, 5.07; P<0.001) and greater tumor thickness (hazard ratio, 1.29 per mm increase; P<0.001). Factors predictive of metastasis included greater tumor base (hazard ratio, 1.21 per mm increase; P<0.001) and increasing intraocular pressure (hazard ratio, 1.11 per mmHg increase; P = 0.020).
Plaque radiotherapy for juxtapapillary melanoma provides local tumor control in approximately 80% of eyes at 10 years. In subjects who received TTT, there was slight but nonsignificant improved local tumor control and lower metastatic rate.
评估瘤旁脉络膜黑色素瘤的敷贴放疗治疗，并探讨补充经瞳孔温热疗法（TTT）的作用。
回顾性、对比病例系列。
我们纳入了 650 只连续的紧邻视盘脉络膜黑色素瘤眼，瘤体距视盘 1mm 以内。
我们纳入了 1974 年 10 月至 2005 年 11 月期间接受敷贴放疗的紧邻视盘脉络膜黑色素瘤眼。分别对 TTT 组和无 TTT 组进行分析和比较。
局部肿瘤控制、转移和肿瘤相关死亡率。
肿瘤基底直径的中位数为 10mm（范围 1.5-21mm），厚度的中位数为 3.5mm（范围 0.5-14.8mm）。在 481 只眼（74%）中，肿瘤直接紧邻视盘，在 169 只眼（26%）中，肿瘤后缘距离视盘为 0.1-1.0mm。肿瘤累及视盘周围的范围＜4 个时钟小时的有 321 只眼（50%），4-8 个时钟小时的有 250 只眼（38%），＞8 个时钟小时的有 79 只眼（12%）。616 只眼（95%）接受碘-125 敷贴放疗，19 只眼（3%）接受钴-60 放疗，12 只眼（2%）接受铱-192 放疗，3 只眼（<1%）接受钌-106 放疗，肿瘤顶点的中位放射剂量为 8000cGy（范围 3600-15500cGy），307 只眼（56%）接受了补充 TTT。Kaplan-Meier 估计，肿瘤复发、转移和死亡的 5 年累积发生率分别为 14%、11%和 4%，10 年累积发生率分别为 21%、24%和 9%。接受额外 TTT 治疗的眼肿瘤复发和转移的发生率略有（统计学上无显著差异）降低。多变量分析显示，肿瘤复发的预测因素包括需要 TTT 的中心凹旁肿瘤（危险比，5.07；P<0.001）和更大的肿瘤厚度（危险比，每增加 1mm 增加 1.29；P<0.001）。肿瘤转移的预测因素包括更大的肿瘤基底（危险比，每增加 1mm 增加 1.21；P<0.001）和眼内压升高（危险比，每增加 1mmHg 增加 1.11；P=0.020）。
瘤旁脉络膜黑色素瘤的敷贴放疗在 10 年内可使约 80%的眼获得局部肿瘤控制。在接受 TTT 的患者中，局部肿瘤控制略有改善，但无统计学意义，转移率也较低。
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