Department of Ophthalmology, University of California, Los Angeles, CA, USA.
Ophthalmology. 2012 May;119(5):1073-7. doi: 10.1016/j.ophtha.2011.11.011. Epub 2012 Jan 31.
To report intraoperative ultrasonography-guided positioning of iodine 125 (I(125)) plaques for brachytherapy of choroidal melanoma as a quality improvement measure.
Retrospective, single-center, consecutive case-cohort study.
One hundred fifty consecutive patients with choroidal melanoma.
Patients with choroidal melanoma who were treated with I(125) plaque brachytherapy from January 2007 through January 2011 with at least 6 months of clinical follow-up were included.
Patient and tumor characteristics at diagnosis were tabulated. The need for plaque repositioning if intraoperative ultrasonography showed the plaque to be either not centered on the tumor or if there was less than 1.0 mm of plaque margin beyond the tumor border was recorded. The rate of local treatment failure and occurrence of distant metastasis were determined.
The average interval from surgery to last follow-up was 21.5 months. Fifty-four (36%) of 150 patients required plaque repositioning. Of tumors located in the macula, equator, and periphery, 15 (36.6%), 26 (36.6%), and 13 (34.2%) required repositioning. There was no case of local treatment failure during a mean follow-up of 21.5 months (range, 6-48 months). Clinical evidence of choroidal melanoma metastasis developed in 9 patients. The cumulative 2-year Kaplan-Meier rate of local treatment failure in the cohort was statistically lower compared with the Collaborative Ocular Melanoma Study, which did not require ultrasonography-guided plaque positioning.
Intraoperative ultrasonography identified the need to reposition I(125) plaques to achieve centration and plaque margin (>1.0 mm) beyond the tumor border in 36% of eyes. Neither tumor size nor tumor location correlated with the need to reposition the plaque. There was no case of local treatment failure during follow-up in this series. Correct plaque position is an essential component of quality outcomes in brachytherapy. Intraoperative ultrasonography reduces geographic errors in placement in eye plaque therapy and may help to reduce local treatment failure in choroidal melanoma.
报告术中超声引导碘 125（I(125)）植入治疗脉络膜黑色素瘤的定位方法，作为一种质量改进措施。
回顾性、单中心、连续病例队列研究。
150 例连续的脉络膜黑色素瘤患者。
纳入 2007 年 1 月至 2011 年 1 月期间接受 I(125) 植入治疗且至少有 6 个月临床随访的脉络膜黑色素瘤患者。
记录患者和肿瘤诊断时的特征。如果术中超声显示植入物未位于肿瘤中心或距肿瘤边界小于 1.0mm，则记录需要重新定位植入物的情况。确定局部治疗失败和远处转移的发生率。
平均手术至末次随访的间隔时间为 21.5 个月。150 例患者中，54 例（36%）需要重新定位植入物。位于黄斑、赤道和周边的肿瘤，需要重新定位的比例分别为 36.6%、36.6%和 34.2%。在平均 21.5 个月（6-48 个月）的随访期间，无局部治疗失败病例。9 例患者出现脉络膜黑色素瘤转移的临床证据。该队列的 2 年累积 Kaplan-Meier 局部治疗失败率低于未行超声引导植入物定位的协作性眼黑色素瘤研究。
术中超声发现，36%的患者需要重新定位 I(125)植入物以实现植入物中心定位和距肿瘤边界大于 1.0mm 的植入物边缘定位。肿瘤大小和位置均与需要重新定位植入物无关。本系列随访中无局部治疗失败病例。正确的植入物位置是眼内植入治疗中获得高质量治疗效果的重要组成部分。术中超声减少了眼内植入治疗中位置的地理误差，可能有助于降低脉络膜黑色素瘤的局部治疗失败率。
