Cappelli Louis, Khan Mehak M, Shields Carol L, Lally Sara E, Sharif Muhammad, Liu Haisong, Chen Yingxuan, Park Jade, Zhan Tingting, Shi Wenyin
Department of Radiation Oncology (L.C., M.S., H.L., Y.C., W.S.), Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Sidney Kimmel Medical College (M.M.K. and J.P.), Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Am J Ophthalmol. 2025 Mar;271:417-423. doi: 10.1016/j.ajo.2024.12.006. Epub 2024 Dec 18.
Uveal melanoma (UM) represents the most prevalent and aggressive intraocular malignancy in adults. This study examined the outcomes of patients diagnosed with high-risk UM who underwent fractionated stereotactic radiosurgery (fSRS) treatment utilizing a novel Linear Accelerator (LINAC)-based frameless technique.
Retrospective, interventional case series.
All patients received fSRS, 50 Gy in 10 Gy/fraction, every other day on a stereotactic LINAC with a novel in-house eye localization and monitoring system. Tumor control, vision outcome, as well as acute and late toxicities were evaluated.
This study included 23 patients with high-risk UM. Median age was 64.8 years old (range 37.9-85.1 years). The Median Karnofsky Performance Score was 90 (range 70-100). The median tumor diameter was 13.5 mm (range 3.0-24.0 mm), and median tumor thickness was 5.05 mm (range 1.2-15.1 mm). There were 11 patients (47.8%) who received prior episcleral plaque. The other 12 patients received stereotactic radiotherapy for initial treatment. With a median follow-up of 38 months, the local control rate was 95.6% at 1 year, 90.1% at 2 years, and 85.6% at 3 years. There was no significant difference between treatment-naïve patients and those who had previously received plaque treatment. Eye preservation rate was 91.3%, with 2 patients required enucleation for tumor progression and/or toxicity. High-grade acute adverse events included 1 patient with grade 3 eye pain. The median best-corrected visual acuity by LogMAR was 0.5 pretreatment (Snellen conversion 20/63) and 1.0 (Snellen 20/200) post-treatment.
Our institution's novel LINAC-based frameless fSRS demonstrated favorable local control and toxicity profile for high-risk UM (tumors deemed unsuitable for episcleral plaque brachytherapy). Patients maintained a high rate of eye preservation. This approach provides an eye preservation option for patients unable to have plaque radiotherapy.
葡萄膜黑色素瘤（UM）是成人中最常见且侵袭性最强的眼内恶性肿瘤。本研究调查了采用基于新型直线加速器（LINAC）的无框架技术进行分次立体定向放射外科治疗（fSRS）的高危UM患者的治疗结果。
回顾性介入病例系列研究。
所有患者均接受fSRS治疗，在配备新型内部眼部定位和监测系统的立体定向LINAC上，每次分割剂量为10 Gy，总剂量50 Gy，隔日一次。评估肿瘤控制情况、视力结果以及急性和晚期毒性反应。
本研究纳入了23例高危UM患者。中位年龄为64.8岁（范围37.9 - 85.1岁）。中位卡诺夫斯基功能状态评分（KPS）为90分（范围70 - 100分）。中位肿瘤直径为13.5 mm（范围3.0 - 24.0 mm），中位肿瘤厚度为5.05 mm（范围1.2 - 15.1 mm）。有11例患者（47.8%）曾接受巩膜外敷贴放疗。另外12例患者接受立体定向放射治疗作为初始治疗。中位随访38个月，1年时局部控制率为95.6%，2年时为90.1%，3年时为85.6%。初治患者与既往接受过敷贴治疗的患者之间无显著差异。眼球保留率为91.3%，2例患者因肿瘤进展和/或毒性反应需要眼球摘除。高级别急性不良事件包括1例3级眼痛患者。治疗前最佳矫正视力的LogMAR中位数为0.5（Snellen换算为20/63），治疗后为1.0（Snellen 20/200）。
我们机构基于新型LINAC的无框架fSRS对高危UM（被认为不适合巩膜外敷贴近距离放疗的肿瘤）显示出良好的局部控制和毒性特征。患者保持了较高的眼球保留率。这种方法为无法进行敷贴放疗的患者提供了一种保留眼球的选择。
