Oxenreiter Monica M, Lane Anne M, Aronow Mary Beth, Shih Helen, Trofimov Alexei V, Kim Ivana K, Gragoudas Evangelos S
Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Br J Ophthalmol. 2022 Apr;106(4):518-521. doi: 10.1136/bjophthalmol-2020-318063. Epub 2020 Dec 21.
To assess treatment outcomes after proton beam irradiation (PBI) without surgical localisation of uveal melanomas involving the iris, ciliary body and anterior choroid.
Retrospective chart review of 125 patients evaluated at Massachusetts Eye and Ear and treated with PBI using a light field set-up without localisation surgery between November 1975 and April 2017. The tumours were characterised as follows: iris (n=18, 14.4%), ciliary body (n=12, 9.6%), iridociliary (n=58, 46.4%), ciliochoroidal (n=24, 19.2%) and iridociliochoroidal (n=13, 10.4%). The tumours were measured by transillumination and ultrasonography before treatment. Tumours with posterior margin located less than two disc diameters from the ora serrata were treated using the light field technique. Patient outcomes after PBI were evaluated.
Most patients had good vision at the time of tumour diagnosis (69.6% had baseline visual acuity (VA) of ≥20/40). Median VA at last follow-up (median follow-up: 72.1 months) was 20/63. Recurrences occurred in 12 patients (9.6%) at a median time of 4.0 years post-treatment. Recurrences were treated by repeat PBI (n=5) or enucleation (n=7). Secondary enucleation was performed in 18 patients (14.4%), and 61.1% of these were due to complications. Neovascular glaucoma (NVG) developed in 21 patients (16.8%). Of seven patients who developed NVG after anti-vascular endothelial growth factor (anti-VEGF) therapies became available, five were treated with intravitreal Avastin injections (23.8% of patients with NVG). Of 69 patients diagnosed with cataract after treatment, 51 (73.9%) were characterised as radiation-related. Death from metastatic uveal melanoma occurred in 20.8% of the cohort, with a median follow-up of 10.1 years.
Patients treated with PBI using a light field set-up technique experience good outcomes after irradiation. Eye preservation and retention of good VA are seen in the majority of cases, and tumour recurrence is low.
评估质子束照射（PBI）治疗累及虹膜、睫状体和脉络膜前部的葡萄膜黑色素瘤且未进行手术定位后的治疗效果。
对1975年11月至2017年4月期间在马萨诸塞州眼耳医院接受评估并采用光野设置的PBI治疗且未进行定位手术的125例患者进行回顾性病历审查。肿瘤特征如下：虹膜（n = 18，14.4%）、睫状体（n = 12，9.6%）、虹膜睫状体（n = 58，46.4%）、睫状体脉络膜（n = 24，19.2%）和虹膜睫状体脉络膜（n = 13，10.4%）。治疗前通过透照法和超声检查测量肿瘤。后缘距锯齿缘小于两个视盘直径的肿瘤采用光野技术治疗。评估PBI治疗后的患者预后。
大多数患者在肿瘤诊断时视力良好（69.6%的患者基线视力（VA）≥20/40）。最后一次随访时的中位视力（中位随访时间：72.1个月）为20/63。12例患者（9.6%）出现复发，中位复发时间为治疗后4.0年。复发患者通过重复PBI（n = 5）或眼球摘除术（n = 7）进行治疗。18例患者（14.4%）进行了二期眼球摘除术，其中61.1%是由于并发症。21例患者（16.8%）发生新生血管性青光眼（NVG）。在抗血管内皮生长因子（抗VEGF）治疗可用后发生NVG的7例患者中，5例接受了玻璃体内注射阿瓦斯汀治疗（占NVG患者的23.8%）。治疗后诊断为白内障的69例患者中，51例（73.9%）为放射性白内障。葡萄膜黑色素瘤转移导致的死亡发生在20.8%的队列中，中位随访时间为10.1年。
采用光野设置技术进行PBI治疗的患者照射后预后良好。大多数病例中可实现眼球保留和良好视力的维持，且肿瘤复发率低。
