Hegde John V, McCannel Tara A, McCannel Colin A, Lamb James, Wang Pin-Chieh, Veruttipong Darlene, Almanzor Robert, Demanes D Jeffrey, Kamrava Mitchell
Department of Radiation Oncology, 200 UCLA Medical Plaza, Suite B265, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
Department of Ophthalmology, Stein Eye Institute, 100 Stein Plaza UCLA, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
Graefes Arch Clin Exp Ophthalmol. 2017 Sep;255(9):1843-1850. doi: 10.1007/s00417-017-3703-0. Epub 2017 Jun 9.
Managing juxtapapillary and circumpapillary choroidal melanoma with brachytherapy is challenging because of technical complications with accurate plaque placement and high radiation toxicity given tumor proximity to the optic nerve. We evaluated our center's experience using ultrasound-guided, Iodine (I)-125 notched plaque brachytherapy for treating choroidal melanoma contiguous with (juxtapapillary) and at least partially surrounding the optic disc (circumpapillary).
All cases of choroidal melanoma treated with I-125 notched plaque brachytherapy at our center from September 2003-December 2013 were retrospectively reviewed. Only patients with ≥18 months of follow-up who had lesions contiguous with the optic disc (0 mm of separation) were included. The tumor apex prescription dose was 85 Gy. Outcomes evaluated included local control, distant metastasis-free survival (DMFS), cancer-specific survival (CSS), overall survival (OS), visual acuity, and radiation toxicity.
Thirty-four patients were included with a median follow-up of 44.1 months (range 18.2-129.0). AJCC T-category was T1 in 58.8%, T2 in 26.5%, and T3 in 14.7%. Median circumferential optic disc involvement was 50% (range 10%-100%). Eye retention was achieved in 94.1%. Actuarial 2- and 4-year rates of local recurrence were 3.1% and 7.6%, DMFS were 97.0% and 88.5%, CSS were 97.0% and 92.8%, and OS were 97.0% and 88.9%, respectively. In addition, 23.5% had visual acuity ≥20/200 at last follow-up.
I-125 notched plaque brachytherapy provides high eye preservation rates with acceptable longer-term post-treatment visual outcomes. Based on our experience, choroidal melanoma directly contiguous with and partially encasing the optic disc may be effectively treated with this technique.
由于在准确放置敷贴器时存在技术并发症，且肿瘤靠近视神经会导致高辐射毒性，因此采用近距离放射治疗来管理视乳头旁和视乳头周围脉络膜黑色素瘤具有挑战性。我们评估了我们中心使用超声引导的碘（I）-125带槽敷贴器近距离放射治疗与视盘相邻（视乳头旁）且至少部分环绕视盘（视乳头周围）的脉络膜黑色素瘤的经验。
回顾性分析2003年9月至2013年12月在我们中心接受I-125带槽敷贴器近距离放射治疗的所有脉络膜黑色素瘤病例。仅纳入随访时间≥18个月且病变与视盘相邻（距离为0毫米）的患者。肿瘤顶点处方剂量为85 Gy。评估的结果包括局部控制、无远处转移生存期（DMFS）、癌症特异性生存期（CSS）、总生存期（OS）、视力和放射毒性。
纳入34例患者，中位随访时间为44.1个月（范围18.2 - 129.0个月）。美国癌症联合委员会（AJCC）T分类中，T1占58.8%，T2占26.5%，T3占14.7%。视盘圆周受累的中位数为50%（范围10% - 100%）。眼球保留率为94.1%。2年和4年的局部复发精算率分别为3.1%和7.6%，DMFS分别为97.0%和88.5%，CSS分别为97.0%和92.8%，OS分别为97.0%和88.9%。此外，在最后一次随访时，23.5%的患者视力≥20/200。
I-
