Dean Mary K, Studenski Matthew T, Paez-Escamilla Manuel A, Walter Scott D, Kwon Deukwoo, Markoe Arnold M, Harbour J William, Samuels Stuart E
Department of Radiation Oncology, University of Miami/Jackson Memorial Hospital, Miami, FL.
Department of Ophthalmology, University of Miami Bascom Palmer Eye Institute, Miami, FL.
Brachytherapy. 2019 May-Jun;18(3):404-410. doi: 10.1016/j.brachy.2019.01.005. Epub 2019 Feb 20.
We sought to formally compare Collaborative Ocular Melanoma Study (COMS) and similar-shaped (circular) eye physics (EP) plaques dosimetrically by examining both tumor coverage and critical structure doses.
The plans of patients with uveal melanoma treated consecutively with eye plaque brachytherapy at a single institution from January 2016 to December 2017 were reviewed. Both a COMS plan and an EP plan using plaques of the same shape were generated for each patient using the Isoaid Plaque Simulator software such that >90% of the tumor + 2 mm margin received 85 Gy over 72 hours from iodine-125 sources. Dose statistics were recorded and analyzed using standard statistical methods.
Plans from a total of 62 patients were analyzed. The mean tumor volume was 0.46 cm (range: 0.02-2.02), and tumors were located on average 5.89 mm (range: 0-15.0) from the macula and 6.25 mm (range: 0-16.0) from the optic disc. All plans met the treatment planning criteria for tumor coverage and were optimized to reduce dose to the adjacent organs at risk. There were no significant differences in the mean doses to the fovea (mean difference [MD] = -0.87 Gy; 95% confidence interval [CI]: -4.90 to 3.16; p = 0.80), macula (MD = -1.02 Gy; 95% CI: -4.15 to 2.11; p = 0.65), or optic disc (MD = 1.07 Gy; 95% CI: -0.77 to 2.91; p = 0.34) between the COMS and circular EP plaques.
Overall, neither the COMS plaques nor the circular EP plaques provided consistently superior dosimetry for the treatment of uveal melanoma. The choice of plaque may be based on other considerations such as cost and surgeon preference.
我们试图通过检查肿瘤覆盖范围和关键结构剂量，从剂量学角度对协作性眼黑色素瘤研究（COMS）和形状相似（圆形）的眼部物理（EP）敷贴器进行正式比较。
回顾了2016年1月至2017年12月在单一机构连续接受眼敷贴近距离放疗的葡萄膜黑色素瘤患者的治疗计划。使用Isoaid敷贴器模拟器软件为每位患者生成一个COMS计划和一个使用相同形状敷贴器的EP计划，使肿瘤+2毫米边缘区域在72小时内从碘-125源接受85 Gy的剂量。使用标准统计方法记录和分析剂量统计数据。
共分析了62例患者的计划。平均肿瘤体积为0.46立方厘米（范围：0.02 - 2.02），肿瘤距黄斑平均5.89毫米（范围：0 - 15.0），距视盘平均6.25毫米（范围：0 - 16.0）。所有计划均符合肿瘤覆盖的治疗计划标准，并进行了优化以减少对相邻危险器官的剂量。COMS和圆形EP敷贴器对中央凹（平均差异[MD]= -0.87 Gy；95%置信区间[CI]：-4.90至3.16；p = 0.80）、黄斑（MD = -1.02 Gy；95% CI：-4.15至2.11；p = 0.65）或视盘（MD = 1.07 Gy；95% CI：-0.77至2.9l；p = 0.34）的平均剂量无显著差异。
总体而言，COMS敷贴器和圆形EP敷贴器在治疗葡萄膜黑色素瘤时均未提供始终更优的剂量学效果。敷贴器的选择可基于其他考虑因素，如成本和外科医生的偏好。
