Arnett Andrea L H, Reynolds Margaret M, Pulido Jose S, Parney Ian F, Laack Nadia N
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
Stereotact Funct Neurosurg. 2017;95(6):363-368. doi: 10.1159/000478271. Epub 2017 Nov 4.
Gamma knife radiosurgery (GKR) can be used for precise targeting of malignant lesions of the CNS when brachytherapy is not an appropriate option.
This study reports treatment technique, efficacy, and radiation-induced adverse effects in patients with primary and metastatic ocular lesions treated with Leksell GKR.
A retrospective, single-institution review was conducted of 28 patients with primary or metastatic ocular disease, treated from 2000 to 2014. The dose to margin was 17-27 Gy (maximum dose 28-54 Gy). Primary outcomes included overall survival (OS), local control, progression-free survival (PFS), and enucleation.
The median age at diagnosis was 70 years, and the median follow-up was 26.4 months. Of the 28 patients, 11 (39%) had metastatic ocular disease, and 17 (61%) were diagnosed with primary ocular melanoma (stage T2a-T4e). The average maximum dose and dose to margin were 41 and 21 Gy, respectively. The mean dose to the optic nerve was 12.6 Gy. The 5-year OS was 46% (95% CI: 23.6-68.4%) for the entire cohort; the 5-year PFS for M0 patients who presented with primary ocular melanoma lesions was 90% (95% CI: 71-100%). Only 1 patient required enucleation after radiation treatment.
GKR is an effective option, with acceptable levels of toxicity, in the treatment of primary and metastatic ocular lesions.
当近距离放射治疗不是合适的选择时,伽玛刀放射外科手术(GKR)可用于精确靶向中枢神经系统恶性病变。
本研究报告了使用Leksell GKR治疗原发性和转移性眼部病变患者的治疗技术、疗效和辐射引起的不良反应。
对2000年至2014年期间治疗的28例原发性或转移性眼部疾病患者进行了一项回顾性单机构研究。边缘剂量为17 - 27 Gy(最大剂量28 - 54 Gy)。主要结局包括总生存期(OS)、局部控制、无进展生存期(PFS)和眼球摘除术。
诊断时的中位年龄为70岁,中位随访时间为26.4个月。28例患者中,11例(39%)患有转移性眼部疾病,17例(61%)被诊断为原发性眼黑色素瘤(T2a - T4e期)。平均最大剂量和边缘剂量分别为41 Gy和21 Gy。视神经的平均剂量为12.6 Gy。整个队列的5年总生存率为46%(95% CI:23.6 - 68.4%);出现原发性眼黑色素瘤病变的M0患者的5年无进展生存率为90%(95% CI:71 - 100%)。放疗后仅1例患者需要进行眼球摘除术。
GKR是治疗原发性和转移性眼部病变的一种有效选择,毒性水平可接受。