Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Ophthalmology, Ikazia Hospital, Rotterdam, The Netherlands.
Acta Ophthalmol. 2022 Aug;100(5):511-519. doi: 10.1111/aos.15029. Epub 2021 Sep 16.
The aim of our study is to evaluate local tumour control rates, radiation side-effects, visual preservation and disease-free survival (DFS) of uveal melanoma (UM) patients treated with fractionated stereotactic radiotherapy (fSRT).
A retrospective study of UM patients, who were treated with fSRT (N = 189), was performed by the Rotterdam Ocular Melanoma Study group (ROMS), the Netherlands, between 1999 and 2014 with a follow-up of at least 5 years.
The 1-, 3-, 5-, 10- and 15-year local tumour control rates were as follows: 99.4%, 92.8%, 92.2%, 89.3% and 89.3%, respectively. Cataract (67.8%) was the most common side-effect of fSRT followed by retinopathy (35.1%), maculopathy (23.8%), vitreous haemorrhage (20.1%), neovascular glaucoma (NVG) (20.0%) and optic neuropathy (12.4%). Patients with anterior located UMs developed cataract more frequently (p = 0.047, multivariable analysis). By multivariable analysis, significant factors for secondary enucleation were tumour recurrence (p < 0.001) and NVG (p < 0.001). In multivariable analysis, risk factors for a worse DFS were larger UM (p = 0.024) and tumours with subretinal fluid (SRF) at baseline (p = 0.038). The 5-year DFS was 77.0% and the best corrected visual acuity decreased significantly after treatment. After 5 years, 22.0% of patients and after 10 years 17.6% of patients had a visual acuity of ≤0.3 logMAR.
Fractionated stereotactic radiotherapy is a good treatment option for small-, medium- and large-sized tumours with 5-year local tumour control of 92.2%. After 5 years, 22.0% of the patients had a good vision. Independently of tumour location, the visual acuity decreased significantly after treatment. Overall, the 5-year DFS was 77.0%.
本研究旨在评估接受分割立体定向放射治疗（fSRT）的葡萄膜黑色素瘤（UM）患者的局部肿瘤控制率、放射副作用、视力保存和无病生存率（DFS）。
荷兰鹿特丹眼部黑色素瘤研究组（ROMS）对 1999 年至 2014 年间接受 fSRT 治疗的 189 例 UM 患者进行了回顾性研究，随访时间至少为 5 年。
1、3、5、10 和 15 年的局部肿瘤控制率分别为 99.4%、92.8%、92.2%、89.3%和 89.3%。fSRT 最常见的副作用是白内障（67.8%），其次是视网膜病变（35.1%）、黄斑病变（23.8%）、玻璃体出血（20.1%）、新生血管性青光眼（NVG）（20.0%）和视神经病变（12.4%）。前位 UM 患者白内障的发生率更高（p=0.047，多变量分析）。多变量分析显示，继发眼球摘除的显著因素是肿瘤复发（p<0.001）和 NVG（p<0.001）。多变量分析显示，DFS 较差的危险因素包括较大的 UM（p=0.024）和基线时存在视网膜下液（SRF）的肿瘤（p=0.038）。5 年 DFS 为 77.0%，治疗后最佳矫正视力显著下降。治疗后 5 年，22.0%的患者和 10 年后，17.6%的患者视力≤0.3 logMAR。
对于小、中、大肿瘤，分割立体定向放疗是一种较好的治疗选择，5 年局部肿瘤控制率为 92.2%。治疗后 5 年，22.0%的患者视力良好。独立于肿瘤位置，治疗后视力明显下降。总体而言，5 年 DFS 为 77.0%。
