Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Ophthalmology. 2021 Jan;128(1):140-151. doi: 10.1016/j.ophtha.2020.06.057. Epub 2020 Jul 8.
To compare tumor control, vision, and complications between patients with a choroidal melanoma of <10 mm in largest basal diameter (LBD) irradiated with 10-mm or 15-mm ruthenium plaques.
Retrospective, comparative case series.
One hundred sixty-four consecutive patients with a choroidal melanoma of <10 mm in LBD, 76 and 88 treated with the 10-mm and 15-mm plaque, respectively, from 1998-2014 in a national ocular oncology service.
Diagnosis was based on growth or high-risk characteristics. The apical dose was 100 to 120 Gy aiming to deliver ≥250 Gy to the sclera. Plaque positioning was modeled retrospectively. An increase of ≥0.3 mm in thickness and ≥0.5 mm in LBD indicated local recurrence. Outcomes were compared with cumulative incidence analysis and Cox regression. Median follow-up time for patients still alive was 8.4 years.
Recurrence rate, low vision, blindness, radiation maculopathy, and optic neuropathy.
Melanomas treated with the 10-mm plaque were smaller (median thickness, 1.9 mm vs. 2.6 mm; LBD, 7.1 mm vs. 8.6 mm) and located closer to foveola (median, 2.0 mm vs. 2.8 mm) than those treated with the 15-mm plaque (P < 0.001). The 2 plaques provided a safety margin in 43% versus 40% eyes, provided no safety margin to guard foveola in 17% versus 33%, and did not entirely cover tumor mainly close to the disc in 32% versus 18% of eyes, respectively (P = 0.052). The incidence of a local recurrence was comparable (13% vs. 15% at 10 years; P = 0.31) and associated with plaque positioning (hazard ratio [HR], 2.81 for no safety margin; P = 0.041). At 5 years, the incidence of low vision was 14% versus 24%, and that of blindness was 3% versus 6%. Distance to the foveola was associated with loss of both levels of vision (HR, 0.65 per 1 mm vs. 0.68 per 1 mm; P ≤ 0.001 vs. P = 0.004). The incidence of radiation maculopathy was comparable (19% vs. 18% at 5 years), whereas that of optic neuropathy tended to be higher with the 15-mm plaque (2% vs. 9%; P = 0.054).
The 10-mm ruthenium plaque contributes to better visual preservation, particularly with tumors close to fovea, without increase in local recurrence rate, and may therefore be preferable to the 15-mm plaque.
比较 10mm 或 15mm 钌盘治疗最大基底直径（LBD）<10mm 的脉络膜黑色素瘤的肿瘤控制、视力和并发症。
回顾性比较病例系列。
1998-2014 年期间，全国眼肿瘤服务中心的 164 例连续脉络膜黑色素瘤患者，LBD<10mm，76 例和 88 例分别接受 10mm 和 15mm 斑块治疗。
诊断基于生长或高危特征。顶剂量为 100-120Gy，旨在向巩膜提供≥250Gy。斑块定位采用回顾性建模。厚度增加≥0.3mm 和 LBD 增加≥0.5mm 表明局部复发。采用累积发生率分析和 Cox 回归比较结果。仍存活患者的中位随访时间为 8.4 年。
复发率、低视力、失明、放射性黄斑病变和视神经病变。
与 15mm 斑块相比，10mm 斑块治疗的黑色素瘤更小（中位厚度为 1.9mm 与 2.6mm；LBD 为 7.1mm 与 8.6mm），并且更靠近黄斑中心凹（中位距离为 2.0mm 与 2.8mm）（P<0.001）。两种斑块在 43%的眼中提供了安全裕度，在 17%的眼中没有为黄斑中心凹提供安全裕度，在 32%的眼中不能完全覆盖主要靠近视盘的肿瘤，而在 18%的眼中不能完全覆盖肿瘤（P=0.052）。局部复发的发生率相似（10 年时为 13%与 15%；P=0.31），与斑块定位相关（无安全裕度的危险比[HR]为 2.81；P=0.041）。5 年后，低视力的发生率为 14%与 24%，失明的发生率为 3%与 6%。与黄斑中心凹的距离与两种视力的丧失相关（HR，每 1mm 为 0.65，每 1mm 为 0.68；P≤0.001 与 P=0.004）。放射性黄斑病变的发生率相似（5 年时为 19%与 18%），而 15mm 斑块的视神经病变发生率较高（2%与 9%；P=0.054）。
10mm 钌盘有助于更好地保留视力，特别是对于靠近黄斑中心凹的肿瘤，同时不会增加局部复发率，因此可能优于 15mm 斑块。
