Department of New Technologies and Translational Research, Division of Radiation Oncology, University Hospital of Pisa, Pisa, Italy;
Department of Ophthalmic Surgery, Division of Ophthalmic Surgery, University Hospital of Pisa, Pisa, Italy.
Anticancer Res. 2022 Apr;42(4):1965-1972. doi: 10.21873/anticanres.15674.
BACKGROUND/AIM: Uveal melanoma (UM) is the most common primary intraocular malignant tumor. This malignancy is frequently treated using brachytherapy, stereotactic radiotherapy, or proton therapy. The objective of this study was to assess the role of stereotactic radiosurgery in the treatment of large and posterior UM.
From January 2014 to July 2021, we treated 65 patients (median age=71 years; range=31-89 years) affected by UM. Inclusion criteria were Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤2, life expectancy >6 months, tumor thickness >10 mm, diameter >16 mm or posterior UM. The treatment was delivered with a True Beam™ LINAC with arc modulation technique. All patients received 27 Gy in one fraction (biological effective dose ≈100 Gy, assuming an α/β of 10).
The median follow-up was 36 (range=3-90) months. Acute toxicities were reported in 14 patients, whereas late toxicity occurred in 45 (69.2%). Fifteen patients (23.0%) underwent enucleation: eight (12.3%) for failure of local control and seven (10.7%) for late treatment co-morbidities. The 5-year local control, and progression-free, metastasis-free, enucleation-free, and overall survival rates were 80%, 43%, 62%, 65% and 56%, respectively. In multivariate analysis, tumor dimensions significantly influenced survival [larger basal diameter: progression-free [hazard ratio (HR)=2.42] and overall (HR=2.61) survival; greater thickness: overall survival (HR=2.36)]. In multivariate analysis, patients without local control had a higher risk of distant metastasis (HR=3.25).
Stereotactic radiosurgery offers an effective and safe approach for selected cases of UM due to the satisfactory results in terms of local control, eye conservation and survival.
背景/目的：葡萄膜黑色素瘤（UM）是最常见的原发性眼内恶性肿瘤。这种恶性肿瘤常采用近距离放射治疗、立体定向放射治疗或质子治疗。本研究的目的是评估立体定向放射外科在治疗大型和后部 UM 中的作用。
从 2014 年 1 月至 2021 年 7 月，我们治疗了 65 例 UM 患者（中位年龄 71 岁；范围 31-89 岁）。纳入标准为东部合作肿瘤学组（ECOG）表现状态（PS）≤2、预期寿命>6 个月、肿瘤厚度>10mm、直径>16mm 或后部 UM。治疗采用 True Beam™ LINAC 弧形调制技术。所有患者均接受 27Gy 单次分割（生物有效剂量约为 100Gy，假设 α/β 为 10）。
中位随访时间为 36（范围 3-90）个月。14 例患者出现急性毒性，45 例（69.2%）出现晚期毒性。15 例患者（23.0%）行眼球摘除术：8 例（12.3%）因局部控制失败，7 例（10.7%）因晚期治疗合并症。5 年局部控制率、无进展生存率、无转移生存率、无眼球摘除生存率和总生存率分别为 80%、43%、62%、65%和 56%。多变量分析显示，肿瘤大小显著影响生存[基底直径越大：无进展[风险比（HR）=2.42]和总生存（HR）=2.61]；厚度越大：总生存（HR）=2.36]）。多变量分析显示，局部控制不佳的患者发生远处转移的风险更高（HR=3.25）。
立体定向放射外科为选择的 UM 病例提供了一种有效且安全的方法，在局部控制、保眼和生存方面取得了令人满意的结果。
