Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom.
Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom; Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.
Ophthalmology. 2023 Sep;130(9):958-965. doi: 10.1016/j.ophtha.2023.05.004. Epub 2023 May 9.
This study evaluated the functional outcome and ocular side effects of patients receiving proton beam radiotherapy (PBR) for the treatment of iris melanoma (IM).
This retrospective study analyzed prospectively collected data.
Patients with IM who underwent PBR as a primary treatment.
Treatment was given in the form of whole PBR (wPBR: n = 51) or segmental PBR (sPBR: n = 98).
Visual acuity (VA) and side effects were divided into ocular surface disease (OSD), secondary glaucoma, or cataract development.
A total of 149 eyes of 149 patients with a mean age of 53.9 ± 16.0 years were included. Tumor recurrence developed in 3 patients (wPBR: 1/51; sPBR: 2/98). Ocular surface disease was observed in 78.4% of the wPBR group (40/51) and 25.5% of the sPBR group (25/98) (P < 0.001) after 0.7 ± 1.2 years and 1.1 ± 0.9 years, respectively. The main side effect was dry eye syndrome in both groups, but severe side effects such as limbal stem cell failure were found only in the wPBR group (4/51; 7.8%). Secondary glaucoma developed in 31.4% of the wPBR group (16/51) compared with 1.0% in the sPBR group (1/98; P < 0.001). Glaucoma control was generally achieved with eye drops, whereas surgery was necessary in 5 patients (wPBR: 4/51, 7.8%; sPBR: 1/98, 1%). Cataract surgery was performed in 47.9% of the wPBR group (23/48) and 19.8% of the sPBR group (19/96) (P < 0.001). Before treatment, VA was 0.14 ± 0.27 logarithm of the minimum angle of resolution (logMAR) in the wPBR group and 0.04 ± 0.19 logMAR in the sPBR group. A worsening was seen in the wPBR group (0.55 ± 0.16 logMAR; P < 0.001) 6 months after radiotherapy, which normalized after 12 months (0.15 ± 0.30 logMAR; P = 0.17). In the sPBR group, no such decrease in VA was observed (6 months: 0.03 ± 0.22 logMAR, P = 0.54; 12 months: 0.04 ± 0.21 logMAR, P = 0.98).
Our results demonstrate that PBR is a very successful treatment option for patients with IM, showing a high tumor control rate and relatively low complication profile. Tumor recurrence was a rare event, and secondary enucleation was not necessary in any patient. Side effects are commonly seen, but severe side effects such as limbal stem cell failure or secondary glaucoma mainly developed after wPBR. These results are important for clinical decision making and discussion with the patient regarding this form of radiotherapy.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
本研究评估了接受质子束放射治疗（PBR）治疗虹膜黑色素瘤（IM）的患者的功能结果和眼部副作用。
这是一项回顾性研究，分析了前瞻性收集的数据。
接受 PBR 作为主要治疗的 IM 患者。
给予全 PBR（wPBR：n=51）或节段性 PBR（sPBR：n=98）治疗。
视力（VA）和副作用分为眼表面疾病（OSD）、继发性青光眼或白内障发展。
共纳入 149 只眼，来自 149 例患者，平均年龄为 53.9±16.0 岁。3 例患者（wPBR：1/51；sPBR：2/98）出现肿瘤复发。wPBR 组（40/51）和 sPBR 组（25/98）分别在 0.7±1.2 年和 1.1±0.9 年后观察到 78.4%（40/51）和 25.5%（25/98）的眼表面疾病（P<0.001）。两组的主要副作用是干眼症，但仅在 wPBR 组发现严重副作用，如角膜缘干细胞衰竭（4/51；7.8%）。wPBR 组继发性青光眼发生率为 31.4%（16/51），而 sPBR 组为 1.0%（1/98；P<0.001）。一般来说，通过滴眼药水控制青光眼，而 5 例患者（wPBR：4/51，7.8%；sPBR：1/98，1%）需要手术。wPBR 组 47.9%（23/48）和 sPBR 组 19.8%（19/96）行白内障手术（P<0.001）。在治疗前，wPBR 组 VA 为 0.14±0.27 最小角分辨率对数视力（logMAR），sPBR 组为 0.04±0.19 logMAR。wPBR 组在放射治疗后 6 个月 VA 恶化（0.55±0.16 logMAR；P<0.001），12 个月后恢复正常（0.15±0.30 logMAR；P=0.17）。sPBR 组 VA 未见下降（6 个月：0.03±0.22 logMAR，P=0.54；12 个月：0.04±0.21 logMAR，P=0.98）。
我们的结果表明，PBR 是治疗 IM 患者的非常成功的治疗选择，具有高肿瘤控制率和相对较低的并发症发生率。肿瘤复发是一种罕见事件，任何患者均无需进行二次眼球摘除。常见副作用，但严重副作用，如角膜缘干细胞衰竭或继发性青光眼，主要发生在 wPBR 后。这些结果对于临床决策以及与患者讨论这种放射治疗形式非常重要。
作者没有与本文讨论的任何材料有关的专有或商业利益。
