评估碘-125上巩膜近距离放射治疗后中小脉络膜黑色素瘤(身高小于5.0mm)的预后。
包括接受碘125近距离放射治疗的中小脉络膜黑色素瘤患者,根尖高度为1.0mm至5.0mm,最大基底直径≤16.0mm。从原始剂量测定计划中提取数据,以确定处方点到顶端高度的视力关键结构的剂量(实际剂量,ABS指南)和,模拟后,处方点高度为5.0毫米(模拟剂量,COMS协议)。视敏度(VA)结果与实际剂量和预测与模拟剂量一起估计局部复发,眼存活率,和5年生存。
共纳入339例患者,平均年龄为61.5岁,平均随访时间为43.4个月。晶状体的平均剂量减少,光盘,中央凹占34%,39.4%,和41.4%,分别与实际剂量与模拟剂量进行比较。对于实际剂量和模拟剂量,Kaplan-Meier估计3年无事件VA率为20/50或更高分别为56%和31%。分别。仅观察到3例局部复发事件(摘除),产生5年局部控制和98%的眼生存率。5年总生存率(OS)和无转移生存率(MFS)分别为95%和87.5%,分别。
根据ABS治疗的小型和中型脉络膜黑色素瘤具有优异的结果。与COMS方案相比,使用ABS指南的近距离放射治疗计划可能与较低的放射毒性和视力丧失率相关。
To assess outcomes of small and medium choroidal melanoma (less than 5.0 mm in height) following Iodine-125 episcleral brachytherapy.
Patients with small and medium choroidal melanoma that underwent Iodine-125 brachytherapy with apical height of 1.0 mm to 5.0 mm and largest basal diameter of ≤16.0 mm were included. Data were extracted from the original dosimetry plans to determine doses to vision critical structures with the prescription point to the apical height (actual dose, ABS
guidelines) and, after simulation, with the prescription point to the height of 5.0 mm (simulated dose, COMS protocol). Visual acuity (VA) outcomes with actual dose and that predicted with the simulated dose were estimated along with local recurrence, ocular survival, and survival at 5 years.
A total of 339 patients with a mean age of 61.5 years with a mean follow up duration of 43.4 months were included. The mean dose reduction for lens, optic disc, and fovea was 34%, 39.4%, and 41.4%, respectively with actual dose when compared with simulated dose. The Kaplan-Meier estimations for 3 year event free rate of VA of 20/50 or better were 56% and 31% for actual dose and simulated dose, respectively. Only 3 events of local recurrence were observed (enucleated) yielding 5 year local control and ocular survival rate of 98%. Overall survival (OS) and metastasis free survival (MFS) were 95% and 87.5% at 5 years, respectively.
Small and medium choroidal melanoma treated according to ABS has excellent outcomes. Brachytherapy planning using ABS
guidelines as compared to COMS protocol may be associated with lower rates of radiation toxicity and vision loss.