视乳头旁脉络膜黑色素瘤的斑块放射治疗。视力和生存结果。
Plaque radiotherapy for juxtapapillary choroidal melanoma. Visual acuity and survival outcome.
作者信息
De Potter P, Shields C L, Shields J A, Cater J R, Brady L W
机构信息
Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pa, USA.
出版信息
Arch Ophthalmol. 1996 Nov;114(11):1357-65. doi: 10.1001/archopht.1996.01100140557006.
OBJECTIVES
To assess the effect of plaque radiotherapy on the visual acuity of patients with juxtapapillary choroidal melanoma and to determine the clinical predictive factors for radiation retinopathy, radiation papillopathy, local tumor recurrence, and distant metastasis.
DESIGN
A retrospective review of the medical records of 93 patients with juxtapapillary choroidal melanoma who were treated initially with plaque radiotherapy.
RESULTS
During a mean follow-up of 78 months, radiation retinopathy developed in 81 patients (87%) and radiation papillopathy developed in 48 patients (52%) after a mean interval of 21 and 27 months, respectively. The univariate variables that were significant predictors of radiation retinopathy were history of diabetes mellitus (P = .05) and use of a notched radioactive plaque (P = .04). The factors predictive of radiation papillopathy were age (> 45 years; P = .01), history of diabetes mellitus (P = .05), mushroom-shaped tumor configuration (P = .006), and nasal location of the tumor (P = .04). By using Kaplan-Meier survival curves, we found that the proportion of the 93 patients with radiation retinopathy was 87 (94%) at 5 years and with radiation papillopathy was 53 (57%) at 5 years. By using life-table analysis, we found that the proportion of the 93 patients who experienced a decrement of at least 3 lines of visual acuity was 67 (72%) by 50 to 60 months. Local tumor recurrence was documented in 14 patients (15%) after a mean interval of 41 months. The age of the patient (< 35 years; P = .02) and the superior (P = .004) and inferior (P = .05) locations of the tumor were predictive of local tumor recurrence. Distant metastasis developed in 11 patients (12%) after a mean interval of 44 months. The factors predictive of distant metastasis were a tumor with a basal diameter larger than 6.0 mm (P = .05), the superior location of the tumor (P = .01), and local tumor recurrence (P < .001).
CONCLUSION
Based on these observations, plaque radiotherapy remains a potential option vs enucleation for the management of juxtapapillary choroidal melanoma.
目的
评估敷贴放射治疗对近乳头脉络膜黑色素瘤患者视力的影响，并确定放射性视网膜病变、放射性视乳头病变、局部肿瘤复发和远处转移的临床预测因素。
设计
对93例最初接受敷贴放射治疗的近乳头脉络膜黑色素瘤患者的病历进行回顾性研究。
结果
在平均78个月的随访期间，分别在平均21个月和27个月后，81例患者（87%）发生放射性视网膜病变，48例患者（52%）发生放射性视乳头病变。放射性视网膜病变的显著预测单变量因素为糖尿病史（P = 0.05）和使用带缺口放射性敷贴（P = 0.04）。放射性视乳头病变的预测因素为年龄（>45岁；P = 0.01）、糖尿病史（P = 0.05）、蘑菇状肿瘤形态（P = 0.006）和肿瘤位于鼻侧（P = 0.04）。通过Kaplan-Meier生存曲线，我们发现93例发生放射性视网膜病变的患者在5年时的比例为87例（94%），发生放射性视乳头病变的患者在5年时的比例为53例（57%）。通过寿命表分析，我们发现93例患者中在50至60个月时视力至少下降3行的比例为67例（72%）。14例患者（15%）出现局部肿瘤复发，平均间隔时间为41个月。患者年龄（<35岁；P = 0.02）以及肿瘤位于上方（P = 0.004）和下方（P = 0.05）是局部肿瘤复发的预测因素。11例患者（12%）发生远处转移，平均间隔时间为44个月。远处转移的预测因素为基底直径大于6.0 mm的肿瘤（P = 0.05）、肿瘤位于上方（P = 0.01）和局部肿瘤复发（P < 0.001）。
结论
基于这些观察结果，对于近乳头脉络膜黑色素瘤的治疗，与眼球摘除术相比，敷贴放射治疗仍是一种潜在的选择。
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