Primary photodynamic therapy with verteporfin for small pigmented posterior pole choroidal melanoma
Primary photodynamic therapy with verteporfin for small pigmented posterior pole choroidal melanoma
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DOI：
10.1038/eye.2017.22
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发表时间：
2017-04-01
期刊：
影响因子：
3.9
通讯作者：
Cohen, V. M. L.
中科院分区：
文献类型：
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作者：
Fabian, I. D.;Stacey, A. W.;Cohen, V. M. L.
目的本研究的目的是探讨初级光动力疗法（PDT）治疗小型后极部脉络膜黑色素瘤的效果。患者和方法对 15 例小型后极部脉络膜黑色素瘤患者进行前瞻性介入连续病例系列研究，这些患者接受了 3 次 PDT 治疗并进行随访。我们评估了失败的风险因素，并将就诊时的结果指标与上次随访时的结果指标进行比较。结果 在中位随访时间 15 个月（平均 14 名，范围 8-18 名）中，12 名 (80%) 患者实现了肿瘤控制。三名患者治疗失败，在第一次 PDT 后平均 5 个月（平均 4 个月，范围 3-6）被诊断出来。在所有失败的病例中，病变部位 100% 着色；新生黑色素瘤而不是转化的痣，并且显示出放射状生长模式而不是厚度增加。所有失败的病例随后均成功接受放射治疗。在该队列中，视网膜下液（SRF）显着减少（P < 0.001），视力没有恶化（P = 0.11），甚至在就诊时患有中心凹下SRF的患者中有所改善（P = 0.018），肿瘤高度显着降低（P = 0.037），并且没有记录到并发症。 80%的患者的短期肿瘤得到控制。 PDT 为患者提供了保留视力的机会，避免了与传统脉络膜黑色素瘤放射治疗相关的视网膜病变。然而，这些肿瘤的长期局部控制仍不确定。
Purpose The purpose of the study was to investigate the outcomes of primary photodynamic therapy (PDT) for small pigmented posterior pole choroidal melanoma.Patients and methods Prospective interventional consecutive case series of 15 patients with small pigmented posterior pole choroidal melanoma, who were treated with three sessions of PDT and followed-up thereafter. Risk factors for failure were assessed and outcome measures at presentation were compared to those at last follow-up visit.Results Tumor control was achieved in 12 (80%) patients in a median follow-up time of 15 months (mean 14, range 8-18). Three patients failed treatment, diagnosed in a median time of 5 months (mean 4, range 3-6), after first PDT. In all failed cases, lesions were 100% pigmented; de novo melanoma rather than transformed nevi and showed a radial growth pattern rather than increased thickness. All failed cases were subsequently successfully treated with radiotherapy. In this cohort, subretinal fluid (SRF) was significantly reduced (P < 0.001), vision did not deteriorate (P = 0.11) and even improved in patients with subfoveal SRF at presentation (P = 0.018), tumor height significantly decreased (P = 0.037) and no complications were recorded.Conclusion Primary PDT was found to be a safe and efficient treatment modality for small pigmented posterior pole choroidal melanoma, achieving short-term tumor control in 80% of patients. PDT offers patients the opportunity to preserve vision by avoiding the retinopathy associated with conventional radiation treatments for choroidal melanoma. However, the long-term local control of these tumors remains uncertain.