Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy.
Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy.
Int J Mol Sci. 2021 Sep 17;22(18):10066. doi: 10.3390/ijms221810066.
Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.
毒性肿瘤综合征（TTS）是一种特别侵袭性的继发性血管病变，发生在眼内放射性治疗葡萄膜黑色素瘤后，由于坏死肿瘤组织的持续存在。TTS 的发展带来了特别不利的功能和解剖学眼部预后，如果不治疗，最终大多数情况下需要眼球摘除。通过使用切除和非切除技术，玻璃体视网膜（VR）手术已成功应用于 TTS 的治疗和预防。在本系统评价中，我们旨在确定最受益于继发性 VR 手术的葡萄膜黑色素瘤的特征，并概述此类情况下 VR 干预的最佳类型和时机。文献分析表明，对于厚度大于 7 毫米且赤道后位置最大基底直径在 8 毫米至 15 毫米之间的肿瘤，尤其是质子束治疗后，应在放疗后 3 个月内进行内切除术。或者，当适当评估时机和适应证时，对于视网膜脱离黄斑脱离、肿瘤直径大于 15 毫米或睫状体受累的眼，内引流仍然是一种有效的治疗选择。当适当评估时机和适应证时，玻璃体视网膜手术可成功治疗放射性治疗葡萄膜黑色素瘤后的 TTS。
