Department of Ophthalmology and Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California 90095, USA.
Br J Ophthalmol. 2013 Jul;97(7):804-11. doi: 10.1136/bjophthalmol-2012-302490. Epub 2013 May 3.
Local treatment failure after globe-conserving therapy for choroidal melanoma is a surgical complication with significant morbidity to the vision and eye. Few reports in the literature have addressed this complication exclusively. A review of the published literature with reference to local treatment failure in the management of choroidal melanoma was performed to make known the potential differences in failure rates between treatment modalities and methods. A search of the literature regarding local treatment failure was performed to identify relevant studies using combinations of the following keywords on PubMed: uveal melanoma, choroidal melanoma, local recurrence, local failure, endoresection, gamma knife, radiotherapy, helium, iodine, proton, palladium, ruthenium, trans-scleral resection, transpupillary thermotherapy. Further studies were found by searching the text and references of previously identified studies for articles reporting local treatment failure rates in choroidal melanoma. Among the 49 studies identified, the local treatment failure rate ranged from 0% to 55.6%, with follow-up ranging from 10 to 150 months. The two most widely used forms of radiation therapy, iodine-125 and ruthenium-106 brachytherapy, were both associated with a local recurrence rate of 9.6%. The weighted-average of treatment failure in all radiation therapies was 6.15% compared with 18.6% in surgical and 20.8% in laser therapies. Rates of local treatment failure for globe-conserving therapy of choroidal melanoma varied widely between modalities and between centres using similar modalities. Radiation therapy overall resulted in lower local treatment failures compared with surgical or transpupillary thermotherapy.
眼球保存疗法治疗脉络膜黑色素瘤后局部治疗失败是一种严重影响视力和眼睛的手术并发症。文献中很少有专门针对这种并发症的报道。本文回顾了已发表的文献，针对脉络膜黑色素瘤治疗中局部治疗失败的问题，旨在明确不同治疗方式和方法之间失败率的潜在差异。通过在 PubMed 上使用以下关键词的组合搜索有关局部治疗失败的文献，以确定相关研究：葡萄膜黑色素瘤、脉络膜黑色素瘤、局部复发、局部失败、内切除术、伽玛刀、放射治疗、氦、碘、质子、钯、钌、经巩膜切除术、经瞳孔温热疗法。通过对之前确定的研究的文本和参考文献进行搜索，发现了更多报道脉络膜黑色素瘤局部治疗失败率的文章。在确定的 49 项研究中，局部治疗失败率从 0%到 55.6%不等，随访时间从 10 到 150 个月不等。两种最广泛使用的放射治疗形式，碘 125 和钌 106 近距离放疗，局部复发率均为 9.6%。所有放射治疗的治疗失败加权平均值为 6.15%，而手术治疗为 18.6%，激光治疗为 20.8%。眼球保存疗法治疗脉络膜黑色素瘤的局部治疗失败率在不同的治疗方式和使用类似治疗方式的不同中心之间差异很大。与手术或经瞳孔温热疗法相比，放射治疗总体上导致较低的局部治疗失败率。
