Shields C L, Shields J A, Cater J, Lois N, Edelstein C, Gündüz K, Mercado G
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Ophthalmology. 1998 Apr;105(4):581-90. doi: 10.1016/S0161-6420(98)94008-8.
The authors evaluated the results of primary transpupillary thermotherapy for choroidal melanoma in 100 cases.
Prospective nonrandomized analysis of treatment method.
One hundred patients with choroidal melanoma were studied.
Tumor response, ocular side effects, and visual results.
Of 100 consecutive patients with choroidal melanoma treated with transpupillary thermotherapy, the mean tumor basal diameter was 7.1 mm and tumor thickness was 2.8 mm. The tumor margin touched the optic disc in 34 eyes (34%) and was beneath the fovea in 42 eyes (42%). Documented growth was present in 64 eyes (64%), and known clinical risks for growth were present in all of the remaining 36 eyes (36%), with an average of 4 of 5 statistical risk factors for growth per tumor. After a mean of three treatment sessions and 14 months of follow-up, the mean tumor thickness was reduced to 1.4 mm. Treatment was successful in 94 eyes (94%) and failed in 6 eyes (6%). Three patients with amelanotic tumors showed no initial response to thermotherapy, but subsequent intravenous indocyanine green administration during thermotherapy resulted in improved heat absorption and tumor regression to a flat scar. The six eyes classified as treatment failures included four eyes with tumors that showed partial or no response to thermotherapy, thus requiring plaque radiotherapy or enucleation, and two eyes with recurrence, subsequently controlled with additional thermotherapy. After treatment, the visual acuity was the same (within 1 line) or better than the pretreatment visual acuity in 58 eyes (58%) and worse in 42 eyes (42%). The main reasons for poorer vision included treatment through the foveola for subfoveal tumor (25 eyes), retinal traction (10 eyes), retinal vascular obstruction (5 eyes), optic disc edema (1 eye), and unrelated ocular ischemia (1 eye). Temporal location (versus nasal and superior, P = 0.02) and greater distance from the optic disc (P = 0.04) were risks for retinal traction.
Transpupillary thermotherapy may be an effective treatment for small posterior choroidal melanoma, especially those near the optic disc and fovea. Despite satisfactory local tumor control, ocular side effects can result in decreased vision. Longer follow-up will be necessary to assess the impact of thermotherapy on ultimate local tumor control and metastatic disease.
作者评估了100例脉络膜黑色素瘤患者接受原发性经瞳孔温热疗法的结果。
对治疗方法进行前瞻性非随机分析。
研究了100例脉络膜黑色素瘤患者。
肿瘤反应、眼部副作用及视力结果。
在连续100例接受经瞳孔温热疗法治疗的脉络膜黑色素瘤患者中，肿瘤基底平均直径为7.1mm，肿瘤厚度为2.8mm。34只眼（34%）的肿瘤边缘触及视盘，42只眼（42%）的肿瘤位于黄斑中心凹下方。64只眼（64%）有记录的肿瘤生长，其余36只眼（36%）均存在已知的生长临床风险因素，每个肿瘤平均有4项（共5项）生长的统计学风险因素。经过平均3次治疗和14个月的随访，肿瘤平均厚度降至1.4mm。94只眼（94%）治疗成功，6只眼（6%）治疗失败。3例无色素性肿瘤患者对温热疗法最初无反应，但在温热疗法期间随后静脉注射吲哚菁绿导致热吸收改善，肿瘤消退至扁平瘢痕。6只被归类为治疗失败的眼中，4只眼的肿瘤对温热疗法部分或无反应，因此需要进行敷贴放疗或眼球摘除，2只眼复发，随后通过额外的温热疗法得到控制。治疗后，58只眼（58%）的视力与治疗前相同（相差不超过1行）或更好，42只眼（42%）的视力更差。视力变差的主要原因包括针对黄斑中心凹下肿瘤经黄斑中心凹治疗（25只眼）、视网膜牵引（10只眼）、视网膜血管阻塞（5只眼）、视盘水肿（1只眼）和无关的眼部缺血（1只眼）。颞侧位置（与鼻侧和上方相比，P = 0.02）以及与视盘距离更远（P = 0.04）是视网膜牵引的风险因素。
经瞳孔温热疗法可能是治疗后部小脉络膜黑色素瘤的有效方法，尤其是那些靠近视盘和黄斑中心凹的肿瘤。尽管局部肿瘤控制效果令人满意，但眼部副作用可能导致视力下降。需要更长时间的随访来评估温热疗法对最终局部肿瘤控制和转移性疾病的影响。
