Kubicka-Trzaska Agnieszka, Romanowska-Dixon Bozena
Clinic of Ophthalmology and Ocular Oncology, Department of Ophthalmology, Jagiellonian University, Medical College, Kraków, Poland.
Klin Oczna. 2011;113(10-12):307-13.
To determine the effect of radioactive plaque therapy on blood vessel behaviour in choroidal melanomas using indocyanine green (ICG) angiography.
Fifty-five patients with choroidal melanoma were studied. Ruthenium-106 plaques were used in 30 eyes, in 11 the "sandwich method" (Ruthenium-106 plaque with transpupillary thermotherapy), was applied and 14 tumours were treated with Iodine-125. In all cases ICG angiography was performed prior to treatment and 12 months after, and at different time afterwards. Baseline tumour microcirculation patterns (MCPs) were studied prior to treatment and post-treatment blood vessels changes were evaluated. Total follow-up period ranged from 14-22 months (mean: 16 months).
Pre-treatment ICG angiography revealed complex MCPs, combining parallel with cross-linking, arcs with branching, loops and networks patterns in 23 (41.8%) and non-complex MCPs, including straight, parallel without cross-linking and arcs without branching patterns in 32 (58.2%) melanomas. Twelve months after treatment, 38 tumours (69.1%) showed a significant changes in their MCPs. The mean ultrasonographic regression rate in tumours with complex MCPs was 57.4% as opposed to 36.2% in the group with non-complex MCPs (p = 0.01). No statistically significant correlation in the height regression rate was found among the various methods of therapy, however a significant difference between the type of therapy and MCPs changes was observed (p < 0.001). Melanomas treated with Ruthenium-106 and TTT demonstrated slight or no MCPs changes, while tumours treated with Ruthenium-106 and Iodine-125 plaques alone showed a significant MCPs changes (p < 0.001). The statistical analysis showed the correlation between the type of baseline MCPs and the degree of their changes after treatment (p < 0.001). Tumours with networks, loops, arcs with branching and parallel with crossing showed an increased regression as compared to other MCPs. Twelve patients whose tumours contained complex MCPs developed metastatic disease.
This study suggests that the response of choroidal melanoma to irradiation is related to MCPs as identified by ICG angiography; the presence of complex MCPs is associated with a high regression rate after plaque therapy and a high risk of development of systemic metastatic disease.
使用吲哚菁绿（ICG）血管造影术确定放射性斑块治疗对脉络膜黑色素瘤血管行为的影响。
对55例脉络膜黑色素瘤患者进行了研究。30只眼使用了钌 - 106斑块，11只眼采用了“三明治法”（钌 - 106斑块联合经瞳孔温热疗法），14个肿瘤采用碘 - 125治疗。所有病例在治疗前、治疗后12个月及之后的不同时间均进行了ICG血管造影。在治疗前研究基线肿瘤微循环模式（MCPs），并评估治疗后血管变化。总随访期为14 - 22个月（平均：16个月）。
治疗前ICG血管造影显示，23例（41.8%）黑色素瘤的MCPs为复杂模式，包括平行与交联、弧形与分支、环状和网状模式，32例（58.2%）为非复杂模式，包括直线、无交联的平行和无分支的弧形模式。治疗12个月后，38个肿瘤（69.1%）的MCPs有显著变化。复杂MCPs肿瘤的平均超声消退率为57.4%，而非复杂MCPs组为36.2%（p = 0.01）。在各种治疗方法之间，高度消退率未发现有统计学意义的相关性，然而观察到治疗类型与MCPs变化之间存在显著差异（p < 0.001）。用钌 - 106和经瞳孔温热疗法治疗的黑色素瘤MCPs变化轻微或无变化，而单独用钌 - 106和碘 - 125斑块治疗的肿瘤MCPs有显著变化（p < 0.001）。统计分析显示基线MCPs类型与治疗后其变化程度之间存在相关性（p < 0.001）。与其他MCPs相比，具有网状、环状、有分支的弧形和平行且有交叉的肿瘤消退增加。12例肿瘤含有复杂MCPs的患者发生了转移性疾病。
本研究表明脉络膜黑色素瘤对放疗的反应与ICG血管造影所确定的MCPs有关；复杂MCPs的存在与斑块治疗后高消退率及全身转移性疾病发生的高风险相关。
