Posttreatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanomas: Dose and dose rate effects
Posttreatment visual acuity in patients treated with episcleral plaque therapy for choroidal melanomas: Dose and dose rate effects
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DOI：
10.1016/s0360-3016(01)02723-7
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发表时间：
2002-03-15
影响因子：
7
通讯作者：
Erickson, B
中科院分区：
文献类型：
--
作者：
Jones, R;Gore, E;Erickson, B
目的：确定接受 125 1 巩膜外斑块放疗的脉络膜黑色素瘤患者的长期视功能与关键眼部结构的剂量和剂量率之间的关系。 方法和材料：从 1987 年至 1994 年，63 名患者接受了 125 1 巩膜外斑块（合作眼部黑色素瘤研究 [COMS] 设计）应用治疗脉络膜黑色素瘤。平均肿瘤高度为 4.5 毫米（范围 1.7-8.3）。计算肿瘤顶点、黄斑和视盘的剂量和剂量率。对 43 条记录进行评分，以评估标准斯内伦视力表上的视力下降是否超过 2 行。记录患者年龄以及是否存在高血压或糖尿病。通过统计分析来评估视力下降的发生率以及导致视力下降的重要因素的存在。结果：中位随访时间为 36 个月，3 年精算生存率为 93.6%。 3年精算本地控制率为86.9%。治疗后视力丧失的中位时间为 18.7 个月。 3年视力保存精算率为40.5%。多变量分析表明，较高的黄斑剂量率 (p = 0.003) 可以预测视力下降。 111 +/- 11.1 cGy/h 的黄斑剂量率与 50% 的显着视力丧失风险相关。结论：我们系列中接受 I-125 斑块近距离放射治疗脉络膜黑色素瘤的患者经历了良好的肿瘤控制，但视力下降的发生率可测量。黄斑的较高剂量率与较差的治疗后视力结果密切相关。该信息对于选择治疗脉络膜黑色素瘤的最佳剂量率和预测视力下降的风险可能很有价值。 (C) 2002 爱思唯尔科学公司。
Purpose: To determine the relationship between the long-term visual function and the dose and dose rates delivered to critical ocular structures in patients with choroidal melanoma treated with 125 1 episcleral plaque radiotherapy.Methods and Materials: From 1987 to 1994, 63 patients underwent 125 1 episcleral plaque (Collaborative Ocular Melanoma Study [COMS] design) application for the treatment of choroidal melanoma. The mean tumor height was 4.5 mm (range 1.7-8.3). Doses and dose rates at the tumor apex, macula, and optic disc were calculated. Forty-three records were scored to assess whether a decrease in visual acuity of >2 lines on a standard Snellen eye chart had occurred. Patient age and the presence of hypertension or diabetes were noted. Statistical analysis was performed to assess both the rate at which visual decline had occurred and the presence of significant factors that had contributed to this decline.Results: With a median follow-up of 36 months, the 3-year actuarial survival rate was 93.6%. The 3-year actuarial local control rate was 86.9%. The median time to visual loss after therapy was 18.7 months. The 3-year actuarial rate of visual preservation was 40.5%. Multivariate analysis demonstrated higher macula dose rates (p = 0.003) to forecast visual decline. Macula dose rates of 111 +/- 11.1 cGy/h were associated with a 50% risk of significant visual loss.Conclusion: Patients in our series treated with I-125 plaque brachytherapy for choroidal melanoma experienced favorable tumor control, but with a measurable incidence of visual decline. Higher dose rates to the macula correlated strongly with poorer posttreatment visual outcome. This information may be valuable in selecting the optimal dose rates to treat choroidal melanomas and to predict the risk of visual decline. (C) 2002 Elsevier Science Inc.