Istanbul University Cerrahpasa Medical School, Ophthalmology Department, Ocular Oncology Service, Abacımahmut Sokak No:7-9 Daire:6, 34093 Aksaray, Istanbul, Turkey.
Graefes Arch Clin Exp Ophthalmol. 2013 Jan;251(1):285-94. doi: 10.1007/s00417-012-2144-z. Epub 2012 Sep 4.
This study investigated the use of gamma-knife-based stereotactic radiosurgery (GKRS) for medium- and large-sized posterior uveal melanoma treatment.
We assessed 50 eyes from 50 consecutive patients with uveal melanoma who were treated with GKRS. All tumors met the criteria for medium- and large-sized uveal melanomas. Patients underwent a single session treatment under local anesthesia; the prescribed radiation dose at the tumor periphery was standardized to 30 Gy at the 50 % isodose field for all patients. The main outcomes were local tumor control, eye retention, and survival rates.
The median follow-up time was 40 months (16-78 months). The baseline mean tumor diameter was 10.3 mm (7.1-15.7 mm) and the apical tumor height was 8.7 mm (4.1-16.8 mm). After treatment, the mean tumor diameter was 8.7 mm (5.5-12.0 mm) and the tumor height was 6.2 mm (0.5-11.2 mm). Changes in both tumor height and diameter were statistically significant (p < 0.001). The tumor control rate was 90 %, and the eye retention rate was 82 %. A total of nine patients (18 %) developed metastasis, and seven (14 %) died due to metastasis during follow-up. Cataracts (34 %) and radiation maculopathy (30 %) were the most frequent complications, and 14 % of patients developed neovascular glaucoma. Visual acuity (VA) decreased significantly after treatment (p < 0.0001).
Treatment using low doses of GKRS, (30 Gy) is an eye-sparing outpatient option for patients with medium- or large-sized posterior uveal melanomas who are not eligible for brachytherapy or particle therapy. Complications, particularly impaired VA, should be taken into consideration.
本研究调查了伽玛刀立体定向放射外科（GKRS）在中大型脉络膜黑色素瘤治疗中的应用。
我们评估了 50 例连续脉络膜黑色素瘤患者的 50 只眼，这些患者均接受 GKRS 治疗。所有肿瘤均符合中大型脉络膜黑色素瘤标准。患者在局部麻醉下进行单次治疗；所有患者的肿瘤边缘处方剂量标准化为 30 Gy 时，50%等剂量场。主要结果是局部肿瘤控制、眼球保留和生存率。
中位随访时间为 40 个月（16-78 个月）。基线平均肿瘤直径为 10.3mm（7.1-15.7mm），顶部长肿瘤高度为 8.7mm（4.1-16.8mm）。治疗后，平均肿瘤直径为 8.7mm（5.5-12.0mm），肿瘤高度为 6.2mm（0.5-11.2mm）。肿瘤高度和直径的变化均具有统计学意义（p<0.001）。肿瘤控制率为 90%，眼球保留率为 82%。共有 9 例（18%）发生转移，7 例（14%）在随访期间因转移死亡。白内障（34%）和放射性黄斑病变（30%）是最常见的并发症，14%的患者发生新生血管性青光眼。治疗后视力（VA）明显下降（p<0.0001）。
对于不符合近距离放射治疗或粒子治疗适应证的中大型后脉络膜黑色素瘤患者，使用低剂量 GKRS（30 Gy）是一种保留眼球的门诊治疗选择。应考虑并发症，特别是视力受损。
