McCannel Tara A, Kamrava Mitchell, Demanes Jeffrey, Lamb James, Bartlett John D, Almanzor Robert, Chun Melissa, McCannel Colin A
Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA.
Doheny Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA.
Graefes Arch Clin Exp Ophthalmol. 2016 Dec;254(12):2461-2467. doi: 10.1007/s00417-016-3485-9. Epub 2016 Sep 16.
To review outcomes in mostly large uveal melanoma treated with a 23-mm-diameter iodine-125 plaque, the largest size available at our center, and the influence of vitrectomy and silicone oil 1000 centistokes for radiation attenuation.
A one-to-one matched case-control comparison was performed. Case patients were treated with a 23-mm-diameter iodine-125 plaque and vitrectomy with silicone oil 1000-cSt placement. Control cases, treated with 23-mm plaque alone, were matched to cases with respect to tumor size and distance from tumor apex to optic nerve and fovea. Postoperative complications, visual acuity and metastasis were reviewed.
Twenty case patients with uveal melanoma treated with a 23-mm plaque were identified. The final logMAR vision was 0.83 in case patients and 2.06 in control patients (P = 0.0064); the change from pre-treatment to last follow-up logMAR vision was 0.70 in cases and 1.62 in controls (P = 0.019). Of good vision outcomes, 65 % of cases and 25 % of controls achieved vision ≥20/200 (P = 0.025). Of poor vision outcomes, 35 % of cases and 80 % of controls achieved vision <20/200 (P = 0.0053), and 5 % of cases and 35 % of controls achieved "light perception" or "no light perception" vision (P = 0.044). Thirty-nine of the 40 eyes (98 %) achieved local tumor control. Metastasis occurred in 15 % of cases and 45 % of controls (P = 0.082).
Iodine-125 brachytherapy for mostly large uveal melanoma is effective in achieving local tumor control. Furthermore, combining brachytherapy with vitrectomy and silicone oil 1000-cSt for radiation attenuation significantly improves vision over the use of plaque alone.
回顾使用直径23毫米的碘-125敷贴器（我院可获得的最大尺寸）治疗大多数大型葡萄膜黑色素瘤的疗效，以及玻璃体切除术和1000厘沲硅油对辐射衰减的影响。
进行一对一匹配的病例对照比较。病例组患者接受直径23毫米的碘-125敷贴器及玻璃体切除术并植入1000厘沲硅油治疗。对照组仅接受23毫米敷贴器治疗，根据肿瘤大小、肿瘤顶端至视神经和黄斑的距离与病例组进行匹配。回顾术后并发症、视力和转移情况。
确定了20例接受23毫米敷贴器治疗的葡萄膜黑色素瘤病例组患者。病例组患者最终的最小分辨角对数视力（logMAR）为0.83，对照组为2.06（P = 0.0064）；从治疗前到最后一次随访，病例组logMAR视力变化为0.70，对照组为1.62（P = 0.019）。在视力良好的结果中，65%的病例组和25%的对照组视力≥20/200（P = 0.025）。在视力差的结果中，35%的病例组和80%的对照组视力<20/200（P = 0.0053），5%的病例组和35%的对照组视力为“光感”或“无光感”（P = 0.044）。40只眼中的39只（98%）实现了局部肿瘤控制。病例组转移发生率为15%，对照组为45%（P = 0.082）。
碘-125近距离放射治疗大多数大型葡萄膜黑色素瘤在实现局部肿瘤控制方面是有效的。此外，将近距离放射治疗与玻璃体切除术和1000厘沲硅油联合用于辐射衰减，与单独使用敷贴器相比，能显著改善视力。
