Joye Russell P, Williams Lloyd B, Chan Michael D, Witkin Andre J, Schirmer Clemens M, Mignano John E, Wazer David E, Yao Kevin C, Wu Julian K, Duker Jay S
Ophthalmic Surg Lasers Imaging Retina. 2014 Mar-Apr;45(2):125-31. doi: 10.3928/23258160-20140306-05.
To evaluate the effectiveness of Leksell Gamma Knife stereotactic radio-surgery (Elekta, Stockholm, Sweden) with respect to local tumor control, visual acuity, and radiation side effects for uveal melanoma.
Retrospective, non-comparative case series of 23 patients with uveal melanoma treated with Gamma Knife stereotactic radiosurgery at Tufts Medical Center from 2000 to 2012. Patients received single-fraction stereotactic radiation therapy of 20-25 gray (Gy) (mean: 21.7 Gy), primarily at the 50% isodose line. Follow-up was 4 to 121 months (median: 41.5 months). Main outcome measures included local tumor control, metastasis, visual acuity, and complications of therapy.
In 21 of 23 patients (91%), local control was achieved with a single session of Gamma Knife therapy. Both patients who did not have local control, as well as a third patient (three of 23, 13%) developed liver metastases. Visual acuity was 20/200 or better in eight of 23 patients (35%) at last follow-up. Radiation side effects severe enough to cause vision loss were present in 14 of 23 patients (61%).
Gamma Knife therapy may be an effective alternative to enucleation in patients with uveal melanoma who are deemed less satisfactory candidates for brachytherapy or wish to avoid surgery.
评估Leksell伽玛刀立体定向放射外科治疗（瑞典斯德哥尔摩Elekta公司生产）在葡萄膜黑色素瘤局部肿瘤控制、视力及放射副作用方面的有效性。
对2000年至2012年在塔夫茨医疗中心接受伽玛刀立体定向放射外科治疗的23例葡萄膜黑色素瘤患者进行回顾性、非对照病例系列研究。患者接受单次20 - 25格雷（Gy）（平均：21.7 Gy）的立体定向放射治疗，主要在50%等剂量线。随访时间为4至121个月（中位数：41.5个月）。主要观察指标包括局部肿瘤控制、转移、视力及治疗并发症。
23例患者中有21例（91%）经单次伽玛刀治疗实现了局部控制。2例未实现局部控制的患者以及第3例患者（23例中的3例，13%）发生了肝转移。在最后一次随访时，23例患者中有8例（35%）视力达到或优于20/200。23例患者中有14例（61%）出现了严重到足以导致视力丧失的放射副作用。
对于被认为不太适合近距离放疗或希望避免手术的葡萄膜黑色素瘤患者，伽玛刀治疗可能是眼球摘除术的一种有效替代方法。
