From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA.
Department of Ophthalmology, Mayo Clinic, Rochester, MN.
Asia Pac J Ophthalmol (Phila). 2020 Jan-Feb;9(1):29-38. doi: 10.1097/APO.0000000000000271.
The aim of this study was to determine the impact of age on radiation complications after plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma.
Retrospective cohort study.
Retrospective single-center study of plaque-irradiated uveal melanoma with prophylactic intravitreal bevacizumab at 4-month intervals from July 2000 to January 2018.
Of 1131 eyes in 1131 patients, age was <50 years (n = 231), 50 to 70 years (n = 657), or >70 years (n = 243). Comparison by age category (<50 vs 50-70 vs >70 years) revealed the oldest group presenting with greatest tumor basal diameter (11.3 vs 11.3 vs 12.1 mm, P = 0.03) and worst visual acuity (20/40 vs 20/40 vs 20/50, P = 0.02). After plaque (mean follow-up 40 vs 42 vs 32 months, P < 0.001), radiation complications were most common in the youngest age group, including maculopathy (48% vs 39% vs 28%, P < 0.001), extramacular retinopathy (30% vs 25% vs 16%, P = 0.002), and papillopathy (21% vs 18% vs 12%, P = 0.03). The youngest age group had the highest Kaplan-Meier estimated 48-month cumulative probability for radiation maculopathy (62% vs 46% vs 47%, P = 0.001), extramacular retinopathy (36% vs 34% vs 29%, P = 0.03), and papillopathy (29% vs 26% vs 22%, P = 0.13). On subanalysis, the youngest age group had increased 48-month risk of developing radiation maculopathy when compared with the middle [hazard ratio (HR) = 1.5, P = 0.001] and older (HR = 1.6, P = 0.005) age groups and increased 48-month risk of developing extramacular radiation retinopathy compared with the older age group (HR = 1.5, P = 0.04).
After plaque radiotherapy for uveal melanoma and prophylactic intravitreal bevacizumab at 4-month intervals, patients younger than 50 years old have an increased 48-month risk of radiation maculopathy.
本研究旨在探讨年龄对行敷贴放疗联合 4 个月间隔预防性玻璃体内注射贝伐单抗治疗脉络膜黑色素瘤后发生放射性并发症的影响。
回顾性队列研究。
回顾性单中心研究，纳入 2000 年 7 月至 2018 年 1 月期间行敷贴放疗联合 4 个月间隔预防性玻璃体内注射贝伐单抗治疗的脉络膜黑色素瘤患者。
1131 只眼中有 1131 例患者，年龄<50 岁（n=231）、50-70 岁（n=657）或>70 岁（n=243）。按年龄组（<50 岁组、50-70 岁组和>70 岁组）进行比较，发现最年长组的肿瘤基底直径最大（11.3 毫米比 11.3 毫米比 12.1 毫米，P=0.03），视力最差（20/40 比 20/40 比 20/50，P=0.02）。在接受敷贴治疗（平均随访时间 40 个月比 42 个月比 32 个月，P<0.001）后，最年轻的年龄组放射性并发症最常见，包括黄斑病变（48%比 39%比 28%，P<0.001）、黄斑外视网膜病变（30%比 25%比 16%，P=0.002）和视盘病变（21%比 18%比 12%，P=0.03）。最年轻的年龄组发生放射性黄斑病变的 48 个月累积概率最高（62%比 46%比 47%，P=0.001）、黄斑外视网膜病变（36%比 34%比 29%，P=0.03）和视盘病变（29%比 26%比 22%，P=0.13）。亚组分析显示，与中年龄组（危险比[HR]=1.5，P=0.001）和高龄组（HR=1.6，P=0.005）相比，最年轻的年龄组发生放射性黄斑病变的 48 个月风险增加，与高龄组相比，最年轻的年龄组发生黄斑外放射性视网膜病变的 48 个月风险也增加（HR=1.5，P=0.04）。
对于行敷贴放疗联合 4 个月间隔预防性玻璃体内注射贝伐单抗治疗的脉络膜黑色素瘤患者，年龄<50 岁者发生放射性黄斑病变的 48 个月风险增加。
