Riechardt Aline I, Karle Bettina, Cordini Dino, Heufelder Jens, Budach Volker, Joussen Antonia M, Gollrad Johannes
Department of Ophthalmology, Charité University of Medicine, Berlin, Germany.
Department of Radiation Oncology, Helios Klinikum Emil-von-Behring, Berlin, Germany.
Strahlenther Onkol. 2017 Nov;193(11):943-950. doi: 10.1007/s00066-017-1166-1. Epub 2017 Jun 19.
The aim of this study was to evaluate local tumour control, incidence of radiation-induced glaucoma and associated interventions of sector-based and whole anterior segment proton beam therapy (PBT) for the treatment of iris melanoma.
We retrospectively analysed the data of 77 patients with iris melanoma who underwent PBT applied as 50 CGE in four daily fractions. Of the patients, 47 received PBT with a circular-shaped collimator and 30 with a conformal sector-shaped target volume. Local control, eye preservation and secondary glaucoma were evaluated.
Median follow-up time was 54.9 months. Local tumour control was 100% in patients receiving whole anterior segment irradiation. Two patients developed pigment dispersion in the non-irradiated area after sector-based PBT and received whole anterior segment salvage PBT. The mean volume of ciliary body irradiated was 89.0% and 34.9% for whole anterior segment and lesion-based irradiation, respectively. At the end of follow-up, secondary glaucoma was found in 74.3% of the patients with whole anterior segment irradiation and in 19.2% with sector-based irradiation. Patients with sector-based PBT had a stable visual acuity of logMAR 0.1, while it declined from logMAR 0.1 to 0.4 after whole anterior segment irradiation.
We found a significant reduction in radiation-induced secondary glaucoma and glaucoma-associated surgical interventions and stable visual acuity after sector-based irradiation compared with whole anterior segment irradiation. Sector-based irradiation revealed a higher risk for local recurrence, but selected patients with well-circumscribed iris melanoma benefit from applying a lesion-based target volume when treated with sector-based PBT.
本研究旨在评估扇形和全眼前节质子束治疗（PBT）对虹膜黑色素瘤的局部肿瘤控制情况、放射性青光眼的发生率及相关干预措施。
我们回顾性分析了77例接受PBT治疗的虹膜黑色素瘤患者的数据，PBT剂量为50CGE，分4天给予。其中47例患者使用圆形准直器进行PBT，30例患者使用适形扇形靶区进行PBT。评估局部控制、眼球保留情况及继发性青光眼。
中位随访时间为54.9个月。接受全眼前节照射的患者局部肿瘤控制率为100%。2例患者在扇形PBT后非照射区域出现色素播散，并接受了全眼前节挽救性PBT。全眼前节照射和基于病变照射时，睫状体的平均受照体积分别为89.0%和34.9%。随访结束时，全眼前节照射的患者中74.3%出现继发性青光眼，扇形照射的患者中19.2%出现继发性青光眼。接受扇形PBT的患者视力稳定在logMAR 0.1，而全眼前节照射后视力从logMAR 0.1下降至0.4。
我们发现，与全眼前节照射相比，扇形照射后放射性继发性青光眼及与青光眼相关的手术干预显著减少，视力稳定。扇形照射显示局部复发风险较高，但对于虹膜黑色素瘤边界清晰的特定患者，采用基于病变的靶区进行扇形PBT治疗有益。
