Ares William J, Tonetti Daniel, Yu Jenny Y, Monaco Edward A, Flickinger John C, Lunsford L Dade
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Am J Ophthalmol. 2017 Feb;174:169-174. doi: 10.1016/j.ajo.2016.11.009. Epub 2016 Nov 23.
Uveal metastases are ophthalmologic tumors that have historically been treated by fractionated external beam radiation therapy or invasive brachytherapy. The need for rapid response and less invasive management options led the authors to explore the use of Gamma Knife stereotactic radiosurgery (SRS) for this common problem.
Interventional case series.
To prevent eye movement during the procedure, all 3 patients underwent a retrobulbar anesthetic block followed by magnetic resonance imaging to detect the target. All tumors were treated in a single procedure using the 4C or Perfexion Gamma Knife. The tumors received a minimal tumor dose of 14-20 Gy. Two patients also underwent SRS for additional intracranial metastases.
At follow-up, performed between 4 and 15 months after SRS, all 3 patients demonstrated a reduction in uveal tumor volumes. One patient developed decreased visual acuity secondary to radiation retinopathy.
In this early experience, SRS was found to be an effective management option for uveal metastases associated with systemic cancer. Patients can be screened and treated effectively early after diagnosis using a joint approach between ophthalmologists and neurosurgeons. Systemic oncologic care can continue without interruption.
葡萄膜转移瘤是一种眼科肿瘤，历来采用分次外照射放疗或侵入性近距离放疗进行治疗。由于需要快速反应和侵入性较小的管理选择，作者们探索了使用伽玛刀立体定向放射外科治疗（SRS）来解决这个常见问题。
介入性病例系列。
为防止手术过程中眼球移动，所有3例患者均接受了球后麻醉阻滞，随后进行磁共振成像以检测靶点。所有肿瘤均在一次手术中使用4C型或Perfexion型伽玛刀进行治疗。肿瘤接受的最小肿瘤剂量为14 - 20 Gy。2例患者还接受了SRS治疗其他颅内转移瘤。
在SRS后4至15个月进行随访时，所有3例患者的葡萄膜肿瘤体积均减小。1例患者因放射性视网膜病变导致视力下降。
在这一早期经验中，发现SRS是治疗与全身性癌症相关的葡萄膜转移瘤的一种有效管理选择。使用眼科医生和神经外科医生之间的联合方法，患者在诊断后可早期得到有效筛查和治疗。全身性肿瘤护理可不受干扰地继续进行。
