Department of Ocular Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
Int J Radiat Oncol Biol Phys. 2011 Jun 1;80(2):377-84. doi: 10.1016/j.ijrobp.2010.04.073. Epub 2010 Sep 23.
Enucleation after stereotactic radiotherapy (SRT) for juxtapapillary choroidal melanoma may be required because of tumor progression (TP) or the development of intractable radiation-induced neovascular glaucoma (NVG). We compare pathologic changes and dosimetric findings in those eyes enucleated secondary to NVG as opposed to TP to better understand potential mechanisms.
Patients with juxtapapillary choroidal melanoma treated with SRT (70 Gy in 5 fractions, alternate days over a total of 10 days) at the Princess Margaret Hospital, Toronto, Ontario, Canada, who underwent enucleation between 1998 and 2006 were selected. We correlated dosimetric data based on the patient's original SRT treatment plan with histopathologic findings in the retina, optic nerve head, and anterior chamber. A dedicated ocular pathologist reviewed each case in a blinded fashion.
Ten eyes in ten patients were enucleated after SRT. Six were enucleated secondary to NVG and four secondary to because of TP. Aggressive tumor features such as invasion of the sclera and epithelioid cell type were observed predominantly in the TP group. Retinal damage was more predominant in the NVG group, as were findings of radiation-related retinal vascular changes of fibrinoid necrosis and hyalinization. No conclusive radiation-related effects were found in the anterior chamber. The maximum point dose and dose to 0.1 cc were lower for the anterior chamber as compared with the dose to the tumor, retina, and optic nerve head. The mean 0.1-cc doses to the retina were 69.4 Gy and 73.5 Gy and to the anterior chamber were 4.9 Gy and 17.3 Gy for the NVG group and tumor progression group, respectively.
Our findings suggest that NVG is due to radiation damage to the posterior chamber of the eye rather than primary radiation damage to the anterior segment.
由于肿瘤进展（TP）或难治性放射性诱导新生血管性青光眼（NVG）的发展，立体定向放射治疗（SRT）后可能需要进行视神经鞘内脉络膜黑色素瘤的眼球摘除术。我们比较了因 NVG 而非 TP 而需要进行眼球摘除的眼睛的病理变化和剂量学发现，以便更好地了解潜在的机制。
选择在加拿大安大略省多伦多玛格丽特公主医院接受 SRT（70Gy，5 个分次，10 天内每天交替）治疗的近视盘脉络膜黑色素瘤患者，这些患者在 1998 年至 2006 年间接受了眼球摘除。我们根据患者原始 SRT 治疗计划的剂量学数据与视网膜、视神经头和前房的组织病理学发现进行了相关性分析。一位专门的眼科病理学家以盲法对每个病例进行了审查。
在 SRT 后，10 名患者的 10 只眼被摘除。其中 6 只眼因 NVG 而被摘除，4 只因 TP 而被摘除。侵袭性肿瘤特征，如巩膜浸润和上皮样细胞类型，主要在 TP 组中观察到。NVG 组中视网膜损伤更为明显，而纤维蛋白样坏死和玻璃样变性等与放射相关的视网膜血管变化的发现更为明显。在前房未发现明确的放射相关效应。与肿瘤、视网膜和视神经头相比，前房的最大点剂量和 0.1cc 剂量较低。NVG 组和肿瘤进展组的视网膜平均 0.1cc 剂量分别为 69.4Gy 和 73.5Gy，前房剂量分别为 4.9Gy 和 17.3Gy。
我们的发现表明，NVG 是由于眼后房的放射损伤引起的，而不是前节的原发性放射损伤。
