194只接受伽玛刀放射外科治疗葡萄膜黑色素瘤的眼睛中放射性并发症的预测因素。
Predictive factors of radio-induced complications in 194 eyes undergoing gamma knife radiosurgery for uveal melanoma.
作者信息
Cicinelli Maria Vittoria, Di Nicola Maura, Gigliotti Carmen Rosaria, Battista Marco, Miserocchi Elisabetta, Del Vecchio Antonella, Mortini Pietro, Bandello Francesco, Modorati Giulio Maria
机构信息
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
出版信息
Acta Ophthalmol. 2021 Dec;99(8):e1458-e1466. doi: 10.1111/aos.14814. Epub 2021 Feb 26.
BACKGROUND AND PURPOSE
To report the factors predictive of radio-induced complications (i.e. radiation retinopathy [RR], radiation papillopathy [RP] and neovascular glaucoma [NVG]) in uveal melanoma (UM) patients undergoing gamma knife radiosurgery (GKR).
MATERIALS AND METHODS
Longitudinal cohort study on patients with UM treated at the Ocular Oncology Service, San Raffaele Scientific Institute, Milan, between June 1994 and November 2018. Data were retrospectively reviewed. Rates of GKR-related complications were reported. Variables associated with each complication were investigated using multivariable Cox models and confirmed by logistic regression analysis. Hazard ratio (HR) and 95% confidence intervals (CI) were reported for significant associations.
RESULTS
One hundred ninety-four patients (99 males, 51%) were included, and 184 tumours were primarily located in the choroid (95%). Median follow-up was 57 months (range 6-286). Local control was achieved in 182 eyes (94%), and 152 eyes (78%) experienced at least one radiation-induced complication. Radiation retinopathy was documented in 67 eyes (35%) after a median of 23 months. Older age (HR = 0.97, 95% CI = 0.95-0.99, p = 0.02) had a protective effect for RR. Radiation papillopathy was diagnosed in 35 eyes (18%) after a median of 14 months after GKR. Macular or peripapillary location (HR = 3.06, 95% CI = 1.52-6.16, p = 0.002) was associated with increased risk of RP, while older age was protective (HR = 0.95, 95% CI = 0.93-0.98, p = 0.001). New-onset NVG was found in 53 eyes (27%), and median onset was 28 months. Tumour thickness (HR = 4.41, 95% CI = 2.23-8.72, p < 0.001) and peripapillary location (HR = 2.78, 95% CI = 1.46-5.27, p = 0.002) were the main risk factors associated with NVG.
CONCLUSION
Understanding factors predictive for radiation-related complications in patients undergoing GKR might help for better counselling and treatment planning.
背景与目的
报告接受伽玛刀放射外科治疗（GKR）的葡萄膜黑色素瘤（UM）患者发生放射性并发症（即放射性视网膜病变[RR]、放射性视乳头病变[RP]和新生血管性青光眼[NVG]）的预测因素。
材料与方法
对1994年6月至2018年11月期间在米兰圣拉斐尔科学研究所眼科肿瘤服务中心接受治疗的UM患者进行纵向队列研究。对数据进行回顾性分析。报告与GKR相关的并发症发生率。使用多变量Cox模型研究与每种并发症相关的变量，并通过逻辑回归分析进行确认。报告显著关联的风险比（HR）和95%置信区间（CI）。
结果
纳入194例患者（99例男性，占51%），184个肿瘤主要位于脉络膜（占95%）。中位随访时间为57个月（范围6 - 286个月）。182只眼（94%）实现局部控制，152只眼（78%）发生至少一种放射性并发症。中位23个月后，67只眼（35%）记录到放射性视网膜病变。年龄较大（HR = 0.97，95%CI = 0.95 - 0.99，p = 0.02）对RR有保护作用。GKR后中位14个月，35只眼（18%）被诊断为放射性视乳头病变。黄斑或视乳头周围位置（HR = 3.06，95%CI = 1.52 - 6.16，p = 0.002）与RP风险增加相关，而年龄较大有保护作用（HR = 0.95，95%CI = 0.93 - 0.98，p = 0.001）。53只眼（27%）发现新发NVG，中位发病时间为28个月。肿瘤厚度（HR = 4.41，95%CI = 2.23 - 8.72，p < 0.001）和视乳头周围位置（HR = 2.78，95%CI = 1.46 - 5.27，p = 0.002）是与NVG相关的主要危险因素。
结论
了解接受GKR治疗患者放射性并发症的预测因素可能有助于更好地进行咨询和治疗规划。
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