Department of Oncology, Division of Radiation Oncology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e455-62. doi: 10.1016/j.ijrobp.2011.05.012. Epub 2011 Jun 25.
To report our experience with linear accelerator-based stereotactic fractionated radiotherapy in the treatment of juxtapapillary choroidal melanoma.
We performed a retrospective review of 50 consecutive patients diagnosed with juxtapapillary choroidal melanoma and treated with linear accelerator-based stereotactic fractionated radiotherapy between April 2003 and December 2009. Patients with small to medium sized lesions (Collaborative Ocular Melanoma Study classification) located within 2 mm of the optic disc were included. The prescribed radiation dose was 60 Gy in 10 fractions. The primary endpoints included local control, enucleation-free survival, and complication rates.
The median follow-up was 29 months (range, 1-77 months). There were 31 males and 29 females, with a median age of 69 years (range, 30-92 years). Eighty-four percent of the patients had medium sized lesions, and 16% of patients had small sized lesions. There were four cases of local progression (8%) and three enucleations (6%). Actuarial local control rates at 2 and 5 years were 93% and 86%, respectively. Actuarial enucleation-free survival rates at 2 and 5 years were 94% and 84%, respectively. Actuarial complication rates at 2 and 5 years were 33% and 88%, respectively, for radiation-induced retinopathy; 9.3% and 46.9%, respectively, for dry eye; 12% and 53%, respectively, for cataract; 30% and 90%, respectively, for visual loss [Snellen acuity (decimal equivalent), <0.1]; 11% and 54%, respectively, for optic neuropathy; and 18% and 38%, respectively, for neovascular glaucoma.
Linear accelerator-based stereotactic fractionated radiotherapy using 60 Gy in 10 fractions is safe and has an acceptable toxicity profile. It has been shown to be an effective noninvasive treatment for juxtapapillary choroidal melanomas.
报告我们使用直线加速器立体定向分割放疗治疗视盘旁脉络膜黑色素瘤的经验。
我们对 2003 年 4 月至 2009 年 12 月期间，采用直线加速器立体定向分割放疗治疗的 50 例连续诊断为视盘旁脉络膜黑色素瘤的患者进行了回顾性分析。患者的病变为小至中等大小（协作性眼部黑色素瘤研究分类），位于视盘 2 毫米以内。处方剂量为 60Gy，共 10 次。主要终点包括局部控制、眼球保留生存率和并发症发生率。
中位随访时间为 29 个月（范围，1-77 个月）。男性 31 例，女性 29 例，中位年龄为 69 岁（范围，30-92 岁）。84%的患者有中等大小的病变，16%的患者有小病变。有 4 例局部进展（8%）和 3 例眼球摘除（6%）。2 年和 5 年的局部控制率分别为 93%和 86%。2 年和 5 年的眼球保留生存率分别为 94%和 84%。2 年和 5 年的放射性视网膜病变发生率分别为 33%和 88%，干眼症发生率分别为 9.3%和 46.9%，白内障发生率分别为 12%和 53%，视力丧失[Snellen 视力（十进制等效物），<0.1]发生率分别为 30%和 90%，视神经病变发生率分别为 11%和 54%，新生血管性青光眼发生率分别为 18%和 38%。
使用 60Gy，共 10 次分割的直线加速器立体定向放疗是安全的，具有可接受的毒性谱。它已被证明是一种有效的非侵入性治疗视盘旁脉络膜黑色素瘤的方法。
