King Benjamin, Morales-Tirado Vanessa M, Wynn Henry G, Gao Brad T, Ballo Matthew T, Wilson Matthew W
Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee.
Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee.
Am J Ophthalmol. 2017 Apr;176:40-45. doi: 10.1016/j.ajo.2016.12.022. Epub 2016 Dec 31.
To report the outcomes of survival, local control, visual acuity, and eye retention in patients treated with repeat episcleral plaque brachytherapy (EPBT) for locally recurrent posterior uveal melanoma (PUM).
Retrospective, interventional case series.
Setting: Institutional.
A total of 1201 patients that underwent iodine-125 (I-125) EPBT as primary treatment for PUM between 1985 and 2015.
Development of locally recurrent disease and retreatment with I-125 EPBT.
Clinical records review.
Visual acuity, Kaplan-Meier estimates of survival, local control, metastasis, and loss of the eye over the duration of follow-up.
Twenty-seven patients (13 men) met our inclusion criteria. Median (range) follow-up from initial treatment was 100 months (14-365 months), while median time to local recurrence was 43 months (9-185 months). Median (range) follow-up after retreatment was 47 months (3-120 months). Kaplan-Meier estimate for local control at 5 years was 77.2% (95% confidence interval [CI], 53.29%-89.91%). All marginal recurrences were successfully retreated whereas 6 of 15 patients with central recurrence developed subsequent re-recurrence following salvage EPBT. Median (range) visual acuity was 20/70 (20/20 to counting fingers at 1 foot) at time of recurrence and declined to counting fingers (20/25 to hand motion) at the most recent follow-up examination. Kaplan-Meier estimate for absence of metastatic disease at 5 years was 78.5% (95% CI, 54.77%-90.70%).
Repeat I-125 EPBT offers a viable alternative to enucleation in patients with local recurrence of PUM, yielding high rates of local control with predictable decline in visual acuity.
报告接受重复巩膜敷贴近距离放射治疗（EPBT）的局部复发性后葡萄膜黑色素瘤（PUM）患者的生存、局部控制、视力和眼球保留情况。
回顾性干预病例系列。
机构研究。
1985年至2015年间共有1201例接受碘-125（I-125）EPBT作为PUM主要治疗方法的患者。
局部复发性疾病的发生以及采用I-125 EPBT进行再次治疗。
临床记录回顾。
随访期间的视力、Kaplan-Meier生存估计、局部控制、转移和眼球丧失情况。
27例患者（13例男性）符合我们的纳入标准。从初始治疗开始的中位（范围）随访时间为100个月（14 - 365个月），而局部复发的中位时间为43个月（9 - 185个月）。再次治疗后的中位（范围）随访时间为47个月（3 - 120个月）。5年时局部控制的Kaplan-Meier估计值为77.2%（95%置信区间[CI]，53.29% - 89.91%）。所有边缘复发均成功再次治疗，而15例中心复发患者中有6例在挽救性EPBT后出现后续再次复发。复发时的中位（范围）视力为20/70（20/20至1英尺处数手指），在最近一次随访检查时降至数手指（20/25至手动）。5年时无转移性疾病的Kaplan-Meier估计值为78.5%（95%CI，54.77% - 90.70%）。
重复I-125 EPBT为局部复发的PUM患者提供了一种可行的眼球摘除替代方案，可实现较高的局部控制率，同时视力会有可预测的下降。
