Ces Antonio Piñeiro, Rodriguez Manuel Bande, Sueiro Javier Mosquero, Castro Ana María Carballo, Busto Ramón Lobato, Rodriguez Paula Silva, Pérez María Pardo, Oliva-Ruiz Francisco Ruiz, Teijeiro Maria Jose Blanco
Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Spain.
Radiophysic Department, Spain.
J Contemp Brachytherapy. 2021 Apr;13(2):126-134. doi: 10.5114/jcb.2021.105279. Epub 2021 Apr 14.
Brachytherapy with iodine-125 (I) has been extensively used as a conservative treatment for uveal melanoma (UM). Surgical technique for correct placement of episcleral radioactive plaques (ERP) in UM cases with posterior choroidal location and/or small size can be difficult and inaccurate. In this study, the correct positioning of plaques was assessed by intra-operative ultrasound control.
This was a longitudinal, retrospective study of consecutive 20 patients with UM (small-medium size and/or posterior location) who received I brachytherapy. Location of plaques was adjusted by intra-operative ocular ultrasonography control. To perform ocular intra-operative ultrasonography, a 10 MHz probe was used to longitudinal and transverse bases in corresponding dummy plaques.
The study included 8 males and 12 females, with a mean age of 66.3 years (SD = 14.53), 5 right eyes (RE) and 15 left eyes (LE). In ultrasound examination, 4 UMs were of mushroom morphology and the rest nodular. Means of the size of UM by ultrasound were (mm): Lb: 10.60 (SD = 2.24) × Tb: 9.88 (SD = 1.54) × H: 4.02 (SD = 1.44) (3 cases corresponding to small size of collaborative ocular melanoma study (COMS), and 17 cases to medium). The plaques used were between 14 and 20 mm in diameter, with an average distance between the edge of greater base of the tumor and the edge of plate of 2.44 mm (SD = 0.34). It was necessary to surgically reposition the plaque in 4 cases (20%).
Intra-operative ultrasound control improves the accuracy of radioactive plaque placement for the treatment of medium-small UMs in posterior location. Probably, this technique should be applied in all cases of brachytherapy, regardless of the isotope chosen and the location of tumor mass, in order to perfectly adjust therapeutic position.
碘 - 125（I）近距离放射治疗已被广泛用作葡萄膜黑色素瘤（UM）的保守治疗方法。对于脉络膜后部位置和/或体积较小的UM病例，将巩膜放射性敷贴器（ERP）正确放置的手术技术可能困难且不准确。在本研究中，通过术中超声控制评估敷贴器的正确定位。
这是一项对连续20例接受I近距离放射治疗的UM患者（中小型和/或后部位置）进行的纵向回顾性研究。通过术中眼部超声检查控制敷贴器的位置。为进行眼部术中超声检查，使用10 MHz探头在相应的模拟敷贴器上进行纵向和横向扫描。
该研究包括8名男性和12名女性，平均年龄66.3岁（标准差 = 14.53），5只右眼（RE）和15只左眼（LE）。在超声检查中，4例UM为蘑菇形态，其余为结节状。超声测量的UM大小均值（mm）为：长径：10.60（标准差 = 2.24）×短径：9.88（标准差 = 1.54）×高：4.02（标准差 = 1.44）（3例对应协作性眼部黑色素瘤研究（COMS）的小尺寸，17例为中等尺寸）。使用的敷贴器直径在14至20 mm之间，肿瘤大基底边缘与敷贴器边缘之间的平均距离为2.44 mm（标准差 = 0.34）。有4例（20%）需要通过手术重新定位敷贴器。
术中超声控制提高了放射性敷贴器放置在后部位置的中小型UM治疗中的准确性。可能，无论选择何种同位素以及肿瘤团块的位置如何，这种技术都应应用于所有近距离放射治疗病例中以完美调整治疗位置。
