Riechardt Aline I, Klein Julian P, Cordini Dino, Heufelder Jens, Rehak Matus, Seibel Ira, Joussen Antonia M
Augenklinik/Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
Berlin Protonen at the Helmholtz-Zentrum Berlin für Materialien und Energie, Berlin, Germany.
Graefes Arch Clin Exp Ophthalmol. 2018 Jul;256(7):1325-1332. doi: 10.1007/s00417-018-3929-5. Epub 2018 Feb 20.
This study aims to analyze the effect of salvage proton beam therapy for the treatment of recurrent iris melanoma.
In this clinical case series, we retrospectively analyzed the data of eight patients who underwent proton beam therapy of the whole anterior segment as salvage therapy between 2000 and 2016 for recurrent iris melanoma after resection, ruthenium brachytherapy, or sector proton beam therapy. Two patients received salvage proton beam therapy for repeated tumor relapse. All patients were observed and prepared for proton beam therapy at the Charité and irradiated at the Helmholtz-Zentrum Berlin where they received 50 cobalt Gray equivalents (CGE) in four daily fractions. We investigated survival rates and ocular outcome.
Median follow-up after salvage proton beam therapy was 39 months. No local recurrence was detected during follow-up. One patient died from hepatic metastases 5.5 years after salvage therapy. Secondary glaucoma occurred in seven out of eight patients during follow-up. Two patients had chronic corneal erosion and two other patients presented with corneal decompensation, necessitating Descemet membrane endothelial keratoplasty (DMEK), and perforating keratoplasty. Median visual acuity was 0.2 logMAR before salvage proton beam therapy and 0.7 logMAR at the end of follow-up.
Whole anterior segment salvage proton beam therapy has effectively controlled recurrent iris melanoma in our patients, but has been associated with a high incidence of radiation-induced corneal impairment and secondary glaucoma requiring extensive secondary treatment.
本研究旨在分析挽救性质子束治疗复发性虹膜黑色素瘤的效果。
在这个临床病例系列中，我们回顾性分析了2000年至2016年间8例接受全眼前节质子束治疗作为挽救性治疗的患者的数据，这些患者在切除、钌近距离放射治疗或扇形质子束治疗后出现复发性虹膜黑色素瘤。2例患者因肿瘤反复复发接受挽救性质子束治疗。所有患者在夏里特医院接受观察并为质子束治疗做准备，然后在柏林亥姆霍兹中心接受照射，他们在4天内每天接受50钴戈瑞当量（CGE）的照射。我们调查了生存率和眼部结局。
挽救性质子束治疗后的中位随访时间为39个月。随访期间未检测到局部复发。1例患者在挽救性治疗5.5年后死于肝转移。8例患者中有7例在随访期间发生继发性青光眼。2例患者出现慢性角膜糜烂，另外2例患者出现角膜失代偿，需要进行后弹力层内皮角膜移植术（DMEK）和穿透性角膜移植术。挽救性质子束治疗前的中位视力为0.2 logMAR，随访结束时为0.7 logMAR。
全眼前节挽救性质子束治疗有效地控制了我们患者的复发性虹膜黑色素瘤，但与放射诱导的角膜损伤和需要广泛二次治疗的继发性青光眼的高发生率相关。
