Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; An Nan Hospital, China Medical University, Tainan, Taiwan.
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taiwan; Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taiwan.
J Formos Med Assoc. 2023 Nov;122(11):1117-1124. doi: 10.1016/j.jfma.2023.04.013. Epub 2023 May 29.
To investigate the treatment outcome, visual outcome, and adverse effects of five-fraction stereotactic radiosurgery (SRS) to medium- and large-sized uveal melanoma with a non-invasive eye immobilization device.
Medical records of 14 patients with uveal melanoma receiving SRS with a total dose of 50 Gy in five fractions from 2008 to 2017 were retrospectively reviewed. A non-invasive eye fixation device was used to achieve and monitor eye immobilization.
Local tumor control rates were 85.7% and 75.0% at 2 and 5 years, respectively. The average tumor diameter decreased significantly from 10.0 ± 3.21 mm to 8.36 ± 3.71 mm (p = 0.038) 15 months after SRS, while the average tumor thickness decreased significantly from 5.45 ± 2.21 mm to 4.34 ± 2.29 (p = 0.036) 21 months after SRS. The 5-year metastasis-free survival was 87.5%. The mean best-corrected visual acuity (BCVA) deteriorated from logMAR 0.296 at baseline to logMAR 1.112 at the last individual follow-up visits (p < 0.001). Adverse effects of SRS were comparable to those reported with proton-beam radiotherapy or Gamma knife therapy.
SRS combined with a non-invasive eye immobilization device is an effective and safe alternative eye-preserving treatment for medium- to large-sized uveal melanoma. BCVA at 3 months may be a predictor for BCVA at 1 year.
研究使用非侵入性眼球固定装置的五次分割立体定向放射外科（SRS）治疗中型和大型葡萄膜黑色素瘤的治疗效果、视力结果和不良反应。
回顾性分析 2008 年至 2017 年间 14 例接受 SRS 治疗的葡萄膜黑色素瘤患者的病历，总剂量为 50Gy，分为 5 个剂量。使用非侵入性眼球固定装置实现和监测眼球固定。
局部肿瘤控制率分别为 2 年和 5 年时的 85.7%和 75.0%。SRS 后 15 个月，平均肿瘤直径从 10.0±3.21mm 显著缩小至 8.36±3.71mm（p=0.038），SRS 后 21 个月，平均肿瘤厚度从 5.45±2.21mm 显著缩小至 4.34±2.29mm（p=0.036）。5 年无转移生存率为 87.5%。平均最佳矫正视力（BCVA）从基线时的 logMAR 0.296 恶化至最后一次个体随访时的 logMAR 1.112（p<0.001）。SRS 的不良反应与质子束放疗或伽玛刀治疗报道的相似。
SRS 联合非侵入性眼球固定装置是治疗中大型葡萄膜黑色素瘤的一种有效且安全的保眼治疗方法。3 个月时的 BCVA 可能是 1 年时 BCVA 的预测指标。
