Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Ophthalmology. 2013 May;120(5):1004-11. doi: 10.1016/j.ophtha.2012.10.021. Epub 2013 Jan 21.
To identify risk factors and outcome of scleral necrosis after plaque radiotherapy of uveal melanoma.
Case-control study.
A total of 73 cases with scleral necrosis and 73 controls without necrosis after plaque radiotherapy. Controls were matched for anteroposterior tumor epicenter and follow-up duration.
Plaque radiotherapy with iodine-125, cobalt-60, iridium-192, or ruthenium-106.
Scleral necrosis.
Of 5057 patients treated with plaque radiotherapy for uveal melanoma, 73 (1%) developed radiotherapy-induced scleral necrosis. Scleral necrosis occurred in <1% of patients (3/1140) when plaque radiotherapy was used for tumors <3 mm in thickness, 1% of patients (33/3155) with 3- to 8-mm tumor thickness, and 5% of patients (37/762) with >8-mm-thick tumors. On the basis of tumor location, scleral necrosis was detected after plaque radiotherapy of iris melanoma in 0% of patients (0/91), ciliary body melanoma in 29% of patients (67/235), and choroid melanoma in <1% of patients (6/4731). The mean time interval between plaque radiotherapy and scleral necrosis was 32 months (median, 23 months; range, 4-126 months). The mean basal dimension of scleral necrosis was 4 mm (median, 3 mm; range, 1-15 mm), equivalent to 29% of mean tumor base (median, 24%; range, 6%-100%) and 22% of mean plaque size (median, 19%; range, 5%-75%). Multivariate analysis of factors that predicted clinically evident scleral necrosis included ciliary body (P = 0.0001) and pars plana to ora serrata (P < 0.0001) locations of anterior tumor margin, tumor thickness ≥ 6 mm (P = 0.0001), and radiation dose ≥ 400 Gy to the outer sclera (P = 0.0455). Scleral necrosis remained stable in 48% of patients (35/73), increased in size/severity in 48% of patients (35/73), or progressed to scleral perforation in 4% of patients (3/73) over a mean follow-up of 79 months (median, 54 months; range, 5-351 months). Treatment of scleral necrosis included observation in 81% of patients (59/73), scleral patch graft in 14% of patients (10/73), and enucleation in 5% of patients (4/73).
Scleral necrosis after plaque radiotherapy of uveal melanoma was detected in 1% of cases. Factors predictive of scleral necrosis included increasing tumor thickness, ciliary body and peripheral choroidal location, and higher radiation dose to sclera. Most patients (81%) did not require treatment, and 4% evolved to full-thickness perforation.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
确定眼黑色素瘤瘤灶行放射性敷贴治疗后发生巩膜坏死的风险因素和结局。
病例对照研究。
73 例放射性敷贴治疗后患巩膜坏死的患者和 73 例无巩膜坏死的对照患者。对照患者按肿瘤前后径中心和随访时间进行匹配。
碘-125、钴-60、铱-192 或钌-106 放射性敷贴治疗。
巩膜坏死。
5057 例眼黑色素瘤瘤灶行放射性敷贴治疗的患者中，有 73 例（1%）发生放射性敷贴治疗引起的巩膜坏死。当瘤灶厚度<3 mm 时，放射性敷贴治疗的巩膜坏死发生率<1%（3/1140），瘤灶厚度为 3-8 mm 时为 1%（33/3155），瘤灶厚度>8 mm 时为 5%（37/762）。根据肿瘤位置，巩膜坏死发生在虹膜黑色素瘤瘤灶放射性敷贴治疗患者中 0%（0/91），睫状体黑色素瘤瘤灶放射性敷贴治疗患者中 29%（67/235），脉络膜黑色素瘤瘤灶放射性敷贴治疗患者中<1%（6/4731）。放射性敷贴治疗后发生巩膜坏死的平均时间间隔为 32 个月（中位数，23 个月；范围，4-126 个月）。巩膜坏死的平均基底直径为 4 mm（中位数，3 mm；范围，1-15 mm），相当于平均肿瘤基底的 29%（中位数，24%；范围，6%-100%）和平均敷贴器尺寸的 22%（中位数，19%；范围，5%-75%）。预测临床明显巩膜坏死的多变量分析因素包括睫状体（P = 0.0001）和前肿瘤边界至睫状体平坦部（P<0.0001）位置、肿瘤厚度≥6 mm（P = 0.0001）和外巩膜接受的放射剂量≥400 Gy（P = 0.0455）。73 例患者中，48%（35/73）的巩膜坏死保持稳定，48%（35/73）的巩膜坏死增大/加重，4%（3/73）的患者进展为巩膜穿孔。73 例患者的平均随访时间为 79 个月（中位数，54 个月；范围，5-351 个月）。巩膜坏死的治疗包括 81%（59/73）的患者观察、14%（10/73）的患者行巩膜贴片移植和 5%（4/73）的患者行眼球摘除。
眼黑色素瘤瘤灶放射性敷贴治疗后发生巩膜坏死的比例为 1%。预测巩膜坏死的因素包括肿瘤厚度增加、睫状体和周边脉络膜位置以及外巩膜接受的放射剂量增加。大多数患者（81%）无需治疗，4%的患者进展为全层穿孔。
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