Toutée Adélaïde, Angi Martina, Dureau Sylvain, Lévy-Gabriel Christine, Rouic Livia Lumbroso-Le, Dendale Rémi, Desjardins Laurence, Cassoux Nathalie
Department of Ocular Oncology, Institut Curie, 26, rue Ulm, 75005 Paris, France.
National Cancer Institute IRCCS Foundation, via Venezian, 1, 20133 Milan, Italy.
Cancers (Basel). 2019 Jul 24;11(8):1047. doi: 10.3390/cancers11081047.
There is increasing evidence of the survival benefit of treating uveal melanoma in an early stage, however it is important to discuss with the patient the associated risk of visual loss. We investigated visual outcomes for uveal melanomas staged T1 (T1UM) treated by proton beam radiotherapy (PBR) as a function of their distance to fovea-optic disc. This retrospective study included a cohort of 424 patients with T1UM treated with PBR between 1991 and 2010 with at least a 5-year follow-up. Visual acuity (VA) was analyzed for patients with posterior edge of tumor located at ≥3 mm (GSup3) or <3 mm (GInf3) from fovea-optic disc. The mean follow-up duration was 122 months, no tumor recurrence was observed. The mean baseline and final VA were 20/25 and 20/32 for GSup3 ( = 75), and 20/40 and 20/80 for GInf3 ( = 317) respectively. The frequency of a 20/200 or greater visual conservation was 93.2%(CI95%:87.7-99.1) and 60.1%(CI95%:54.9-65.9) for GSup3 and GInf3 respectively. This difference between groups was statistically significant ( < 0.001). The risk factors for significant VA loss (less than 20/200) were GInf3 location ( < 0.001), tumor touching optic disc ( = 0.04), initial VA inferior to 20/40 ( < 0.001), documented growth ( = 0.002), and age greater than 60 years ( < 0.001). In summary, PBR for T1UM yields excellent tumor control and good long-term visual outcomes for tumors located ≥3 mm from fovea-optic disc.
越来越多的证据表明早期治疗葡萄膜黑色素瘤对生存有益，然而，与患者讨论视力丧失的相关风险很重要。我们研究了质子束放疗（PBR）治疗的T1期葡萄膜黑色素瘤（T1UM）的视力结果与其到黄斑-视盘距离的关系。这项回顾性研究纳入了1991年至2010年间接受PBR治疗且至少随访5年的424例T1UM患者队列。分析了肿瘤后缘距黄斑-视盘≥3 mm（GSup3）或<3 mm（GInf3）患者的视力（VA）。平均随访时间为122个月，未观察到肿瘤复发。GSup3组（n = 75）的平均基线视力和最终视力分别为20/25和20/32，GInf3组（n = 317）分别为20/40和20/80。GSup3组和GInf3组视力保持在20/200或更好的频率分别为93.2%（CI95%：87.7 - 99.1）和60.1%（CI95%：54.9 - 65.9）。两组之间的这种差异具有统计学意义（P < 0.001）。视力显著丧失（低于20/200）的危险因素为GInf3位置（P < 0.001）、肿瘤接触视盘（P = 0.04）、初始视力低于20/40（P < 0.001）、记录的肿瘤生长（P = 0.002）和年龄大于60岁（P < 0.001）。总之，对于距黄斑-视盘≥3 mm的肿瘤，T1UM的PBR可实现出色的肿瘤控制和良好的长期视力结果。
