BC 癌症研究所在眼后极部脉络膜黑色素瘤的质子放射治疗结果。
Outcomes of proton radiation therapy for peripapillary choroidal melanoma at the BC Cancer Agency.
机构信息
BC Cancer Agency, 600 W 10th Ave, Vancouver, British Columbia, V5Z 4E6, Canada.
出版信息
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1425-31. doi: 10.1016/j.ijrobp.2011.10.017. Epub 2011 Dec 29.
PURPOSE
To report toxicity, local control, enucleation, and survival rates for patients with peripapillary choroidal melanoma treated with proton therapy in Canada.
METHODS AND MATERIALS
We performed a retrospective analysis of patients with peripapillary choroidal melanoma (≤ 2 mm from optic disc) treated between 1995 and 2007 at the only Canadian proton therapy facility. A prospective database was updated for follow-up information from a chart review. Descriptive and actuarial data are presented.
RESULTS
In total, 59 patients were treated. The median age was 59 years. According to the 2010 American Joint Committee on Cancer TNM classification, there were 20 T1 tumors (34%), 28 T2 tumors (48%), and 11 T3 tumors (19%). The median tumor diameter was 11.4 mm, and the median thickness was 3.5 mm. Median follow-up was 63 months. Nineteen patients received 54 cobalt gray equivalents (CGE) and forty patients received 60 CGE, each in 4 fractions. The 5-year actuarial local control rate was 91% (T1, 100%; T2, 93%; and T3, 59%) (p = 0.038). There was a suggestive relationship between local control and dose. The local control rate was 97% with 60 CGE and 83% with 54 CGE (p = 0.106). The metastasis-free survival rate was 82% and related to T stage (T1, 94%; T2, 84%; and T3, 47%) (p < 0.001). Twelve patients died, including eleven with metastases. The 5-year actuarial rate of neovascular glaucoma was 31% (23% for T1-T2 and 68% for T3, p < 0.001), and that of enucleation was 0% for T1, 14% for T2, and 72% for T3 (p < 0.001). Radiation retinopathy (74%) and optic neuropathy (64%) were common within-field effects.
CONCLUSIONS
Proton therapy provides excellent local control with acceptable toxicity while conserving the globe in 80% of cases. These results are consistent with other single-institution series using proton radiotherapy, and toxicity rates were acceptable. T3 tumors carry a higher rate of both local recurrence and metastasis.
目的
报告在加拿大接受质子治疗的周边性脉络膜黑色素瘤患者的毒性、局部控制、眼摘和生存率。
方法与材料
我们对 1995 年至 2007 年间在加拿大唯一的质子治疗中心接受治疗的周边性脉络膜黑色素瘤（距视盘≤2 毫米）患者进行了回顾性分析。通过病历回顾更新了前瞻性数据库以获取随访信息。呈现描述性和累积数据。
结果
共治疗了 59 名患者。中位年龄为 59 岁。根据 2010 年美国癌症联合委员会 TNM 分期，20 例为 T1 肿瘤（34%），28 例为 T2 肿瘤（48%），11 例为 T3 肿瘤（19%）。肿瘤直径中位数为 11.4 毫米，厚度中位数为 3.5 毫米。中位随访时间为 63 个月。19 名患者接受 54 钴格雷等效剂量（CGE），40 名患者接受 60 CGE，均为 4 个分次。5 年累积局部控制率为 91%（T1 为 100%；T2 为 93%；T3 为 59%）（p=0.038）。局部控制与剂量之间存在提示性关系。60 CGE 的局部控制率为 97%，54 CGE 的局部控制率为 83%（p=0.106）。无转移生存率为 82%，与 T 分期相关（T1 为 94%；T2 为 84%；T3 为 47%）（p<0.001）。12 名患者死亡，其中 11 名患者发生转移。5 年累积新生血管性青光眼发生率为 31%（T1-T2 为 23%，T3 为 68%，p<0.001），眼球摘除率为 T1 为 0%，T2 为 14%，T3 为 72%（p<0.001）。放射性视网膜病变（74%）和视神经病变（64%）是常见的场内效应。
结论
质子治疗在保留眼球的同时提供了极好的局部控制，毒性可接受。这些结果与其他使用质子放射治疗的单机构系列一致，且毒性发生率可接受。T3 肿瘤的局部复发和转移率均较高。
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