Newman Hadas, Chin Kimberly J, Finger Paul T
The New York Eye Cancer Center, New York City, NY 10065, USA.
Arch Ophthalmol. 2011 Jul;129(7):892-8. doi: 10.1001/archophthalmol.2011.161.
To evaluate the clinical presentation, tumor characteristics, and response to palladium 103 plaque radiation therapy for subfoveal choroidal melanomas.
Retrospective case series of 50 patients diagnosed as having subfoveal melanoma and treated with plaque brachytherapy. Patients underwent evaluation for tumor characteristics, visual acuity, radiation damage, local tumor control, and metastatic disease.
Patients were followed up for a median of 54 (SD, 49.3) months. Forty-nine tumors (98%) were dome shaped. Subretinal fluid (overlying or a dependent exudative retinal detachment) was evident in 34 of 45 patients (76%). Treatment involved an apical radiation dose of 82.8 Gy (delivered across 5-7 days), resulting in a mean dose of 157.7 Gy to the fovea. Pretreatment median visual acuity was 20/50, which declined to 20/180 at last follow-up. Visual acuity was better than 20/200 in 33 patients (66%) at baseline and 25 (50%) at last follow-up; 13 patients (26%) lost 6 or more lines of vision. Twenty-eight patients (56%) developed radiation retinopathy; 16 (32%) required secondary intervention for radiation retinopathy, including intravitreal antivascular endothelial growth factor therapy, laser treatment, cryotherapy, or pars plana vitrectomy. The local tumor control rate of subfoveal tumors was 92%. Four patients (8%) required secondary enucleation. Metastasis developed in 2 patients (4%).
Subfoveal choroidal melanomas in this series are almost exclusively dome shaped and likely to have an associated exudative retinal detachment. They are amenable to plaque radiation therapy. However, this tumor location is associated with a high incidence of radiation maculopathy and a low incidence of radiation cataract.
评估黄斑下脉络膜黑色素瘤的临床表现、肿瘤特征以及对钯103敷贴放射治疗的反应。
对50例诊断为黄斑下黑色素瘤并接受敷贴近距离放射治疗的患者进行回顾性病例系列研究。患者接受了肿瘤特征、视力、放射损伤、局部肿瘤控制和转移性疾病的评估。
患者的中位随访时间为54（标准差，49.3）个月。49个肿瘤（98%）呈圆顶形。45例患者中有34例（76%）可见视网膜下液（覆盖或依赖渗出性视网膜脱离）。治疗的顶点放射剂量为82.8 Gy（在5 - 7天内给予），导致黄斑的平均剂量为157.7 Gy。治疗前的中位视力为20/50，在最后一次随访时降至20/180。33例患者（66%）在基线时视力优于20/200，在最后一次随访时为25例（50%）；13例患者（26%）视力下降6行或更多。28例患者（56%）发生放射性视网膜病变；16例（32%）因放射性视网膜病变需要二次干预，包括玻璃体内抗血管内皮生长因子治疗、激光治疗、冷冻治疗或玻璃体切割术。黄斑下肿瘤的局部肿瘤控制率为92%。4例患者（8%）需要二次眼球摘除术。2例患者（4%）发生转移。
本系列中的黄斑下脉络膜黑色素瘤几乎均为圆顶形，且可能伴有渗出性视网膜脱离。它们适合接受敷贴放射治疗。然而，这种肿瘤位置与放射性黄斑病变的高发生率和放射性白内障的低发生率相关。
