Finger Paul T
The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, New York.
Ophthalmol Sci. 2024 Mar 16;4(5):100513. doi: 10.1016/j.xops.2024.100513. eCollection 2024 Sep-Oct.
To describe a pilot study on the use of single-session, high-dose-rate, Food and Drug Administration-cleared, yttrium-90 (Y) plaque brachytherapy for iris and iridociliary melanoma.
A single-center, clinical case series.
Six consecutive patients were included in this study. Each was diagnosed with an iris or iridociliary melanoma based on clinical examination with or without biopsy.
Each tumor was staged according to the American Joint Committee on Cancer criteria and received Y eye plaque brachytherapy. The main variables were tumor size, patient age, sex, and method of diagnosis (clinical or biopsy). Surgical techniques, treatment durations, and ocular side effects were recorded. Local control was defined as a lack of tumor growth or regression determined by clinical examinations, including slit-lamp and gonio photography, as well as high-frequency ultrasound measurements. Toxicity parameters included acute and short-term corneal/scleral change, anterior segment inflammation, and cataract progression.
Local and systemic cancer control, tumor regression, visual acuity, as well as radiation-related normal tissue toxicity.
High-dose-rate Y plaque brachytherapy was used to treat small (American Joint Committee on Cancer cT1) category melanomas. Single-surgery high-dose-rate irradiations were performed under anesthesia. Because of short treatment durations, high-dose-rate Y did not require the additional procedures used for low-dose-rate plaque (e.g., sutures, amniotic membrane epicorneal buffering, Gunderson flaps, and second surgeries for plaque removal). Only conjunctival recession was used to avoid normal tissue irradiation. High-dose-rate Y treatment durations averaged 8.8 minutes (median, 7.9; range, 5.8-12.9). High-dose-rate Y brachytherapy was associated with no periorbital, corneal (Descemet folds), or conjunctival edema. There was no acute or short-term anterior uveitis, secondary cataract, scleropathy, radiation retinopathy, maculopathy, or optic neuropathy. The follow-up was a mean of 16.0 (range 12-24) months. Evidence of local control included a lack of expansion of tumor borders ( = 6, 100%), darkening with or without atrophy of the tumor surface ( = 5/6, 83%), and a mean 24.5% reduction in ultrasonographically measured tumor thickness. There were no cases of metastatic disease.
High-dose-rate Y brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of iris and iridociliary melanomas.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
描述一项关于使用单疗程、高剂量率、已获美国食品药品监督管理局批准的钇-90（Y）斑块近距离放射疗法治疗虹膜和虹膜睫状体黑色素瘤的初步研究。
单中心临床病例系列。
本研究纳入了连续6例患者。每例患者均根据临床检查（有或无活检）被诊断为虹膜或虹膜睫状体黑色素瘤。
根据美国癌症联合委员会的标准对每个肿瘤进行分期，并接受Y眼斑块近距离放射疗法。主要变量包括肿瘤大小、患者年龄、性别和诊断方法（临床诊断或活检）。记录手术技术、治疗持续时间和眼部副作用。局部控制定义为通过临床检查（包括裂隙灯和前房角摄影以及高频超声测量）确定无肿瘤生长或消退。毒性参数包括急性和短期角膜/巩膜变化、前段炎症和白内障进展。
局部和全身癌症控制、肿瘤消退、视力以及与放射相关的正常组织毒性。
高剂量率Y斑块近距离放射疗法用于治疗小（美国癌症联合委员会cT1）类黑色素瘤。在麻醉下进行单次手术高剂量率照射。由于治疗持续时间短，高剂量率Y不需要用于低剂量率斑块的额外程序（例如缝线、羊膜角膜上皮缓冲、冈德森皮瓣以及用于移除斑块的二次手术）。仅使用结膜退缩来避免正常组织照射。高剂量率Y治疗持续时间平均为8.8分钟（中位数为7.9；范围为5.8 - 12.9）。高剂量率Y近距离放射疗法未导致眶周、角膜（后弹力层褶皱）或结膜水肿。没有急性或短期前葡萄膜炎、继发性白内障、巩膜病变、放射性视网膜病变、黄斑病变或视神经病变。随访平均为16.0（范围12 - 24）个月。局部控制的证据包括肿瘤边界无扩大（n = 6，100%）、肿瘤表面有或无萎缩的变黑（n = 5/6，83%）以及超声测量的肿瘤厚度平均降低24.5%。没有转移性疾病病例。
高剂量率Y近距离放射疗法允许对虹膜和虹膜睫状体黑色素瘤进行单次手术、微创的门诊照射。
在本文末尾的脚注和披露中可能会找到专有或商业披露信息。
