目的:本研究的目的是评估碘(125I)斑块近距离放射治疗在葡萄膜黑色素瘤治疗中的作用。
方法:这是一项对50例葡萄膜黑色素瘤患者(中位年龄67岁;范围=33-86岁)的回顾性研究,在比萨大学医院接受125I斑块近距离放射治疗。葡萄膜黑色素瘤被诊断为A扫描和B扫描标准化回波描记术,荧光素血管造影,吲哚菁绿血管造影术,光学相干层析成像,和/或磁共振成像。评估的主要结果是局部控制,总生存率,疾病进展,地球仪保存,和转移。次要结果是急性和晚期放射不良反应。
结果:纳入标准包括东部肿瘤协作组表现状态≤2,预期寿命>6个月,肿瘤厚度≤10mm,直径≤20mm。所有患者均接受125I斑块近距离放射治疗,以85Gy的处方剂量到达肿瘤顶点。5年局部控制率,无进展生存期,无转移生存率,无摘除存活,总生存率为83.0%,81.4%,90.3%,83.1%,分别为92.1%。24例患者(48.0%)有一种或多种急性和晚期毒性。最常见的急性不良事件(CTCAE与5.0)1-3级为结膜炎和眼痛(6.0%)。关于后期事件,放射性视网膜病变1-3级发生在18.0%的病例中,而1-3级玻璃体出血占2.5%。
结论:125I斑块近距离放射治疗为选定的葡萄膜黑色素瘤病例提供了一种有效且安全的方法,由于报告在当地控制方面取得了令人满意的结果,眼睛保护和生存。
OBJECTIVE: The objective of this study was to assess the role of iodine (125I) plaque brachytherapy in the management of uveal melanoma.
METHODS: This is a retrospective study of 50 patients (median age 67 years; range=33-86 years) with uveal melanoma, treated with 125I plaque brachytherapy at the University Hospital of Pisa. Uveal melanoma was diagnosed with A-scan and B-scan standardized echography, fluorescein angiography, indocyanine green-angiography, optical coherence tomography, and/or magnetic resonance imaging. The primary outcomes assessed were local control, overall survival, disease progression, globe preservation, and metastases. Secondary outcomes were acute and late radiation adverse effects.
RESULTS: Inclusion criteria comprised Eastern Cooperative Oncology Group performance status ≤2, life expectancy >6 months, and tumor thickness ≤10 mm and\\or diameter ≤20 mm. All the patients were treated with 125I plaque brachytherapy, with a prescription dose of 85 Gy to the tumor apex. The 5-year rate of local control, progression-free survival, metastasis-free survival, enucleation-free survival, and overall survival were 83.0%, 81.4%, 90.3%, 83.1%, and 92.1% respectively. Twenty-four patients (48.0%) had one or more acute and late toxicities. The most common acute adverse events (CTCAE vs. 5.0) grade 1-3 were conjunctivitis and eye pain (6.0%). Regarding late events, radiation retinopathy grade 1-3 occurred in 18.0% of cases, while grade 1-3 vitreous hemorrhage in 2.5%.
CONCLUSIONS: 125I plaque brachytherapy offers an effective and safe approach for selected cases of uveal melanoma, due to the reported satisfactory results in terms of local control, eye conservation and survival.