碳离子放射治疗后脉络膜恶性黑色素瘤的眼部及视力保存的长期结局

Long-Term Outcomes of Ocular and Visual Preservation After Carbon Ion Radiation Therapy for Choroidal Malignant Melanoma

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS

影响因子:6.5

分区:医学1区 Top / 肿瘤学2区核医学2区

发表日期:2025 Mar 15

作者: Shuri Aoki, Masaru Wakatsuki, Hiroshi Tsuji, Hirokazu Makishima, Hiroaki Ikawa, Shigeru Yamada, Yuji Inoue, Hiroshi Goto, Shigenobu Suzuki, Toshinobu Kubota, Hitoshi Ishikawa, Atsushi Mizota

DOI: 10.1016/j.ijrobp.2024.10.008

摘要

本研究旨在评估碳离子放射治疗（CIRT）对脉络膜恶性黑色素瘤（CMM）的长期效果，特别是关于眼睛保护和视力（VA）的保持情况。纳入了2003年1月至2021年9月期间接受CIRT治疗的250例眼内局部性CMM患者。剂量处方包括60至85 Gy/4至5次分次，2018年起仅使用68 Gy/4次。2018年4月引入了扫描束旋转机架系统。不良事件（AEs）按照《共同术语标准第5.0版》进行分级。对于继发性青光眼，排除了肿瘤相关的视野缺损的评估。VA方面，随访了245名VA≥光感受阈（LP）的患者，采用有效VA（≥20/200，斯奈伦等价）、认指和LP作为指标。患者中位年龄为55岁（15-86岁）。T分期1、2、3和4的患者分别为16（6.4%）、41（16.4%）、189（75.6%）和4（1.6%）例。中位随访时间为72.5个月，5年和8年的总生存率分别为87.5%和84.2%；局部控制率分别为94.4%和92.9%。在最后随访时，19例（7.6%）患者进行了摘除眼球，其中15例由于局部复发，4例因不良事件。继发性青光眼分级1、2、3至4的患者分别为22（8.8%）、49（19.6%）和5（2.0%）。在最后随访时，≥有效VA、≥认指和≥LP的患者分别为80（33%）、120（49%）和154（63%）。5年和8年后，≥LP视力的保存率分别为65.7%和55.3%。CMM的CIRT在肿瘤控制以及眼睛和视力的保存方面是具有前景的治疗方法。

Abstract

This study aimed to evaluate the long-term results of carbon ion radiation therapy (CIRT) for choroidal malignant melanoma (CMM), especially regarding the preservation of the eye and visual acuity (VA).A total of 250 patients with intraocularly localized CMM treated with CIRT between January 2003 and September 2021 were included. The dose prescription included 60 to 85 Gy/4 to 5 fr, with only 68 Gy/4 fr used from 2018 onward. The rotating gantry system with scanning beams was introduced in April 2018. Adverse events (AEs) were graded according to the Common Terminology Criteria for AEs (version 5.0.). For secondary glaucoma, tumor-related visual field defects were excluded from the evaluation. For VA, 245 patients with VA ≥ light perception (LP) were followed up. Effective VA (≥20/200, Snellen equivalent), counting fingers, and LP were used as indicators.The median age was 55 (15-86) years. The T categories 1, 2, 3, and 4 were observed in 16 (6.4%), 41 (16.4%), 189 (75.6%), and 4 (1.6%) patients, respectively. With a median follow-up of 72.5 months, the 5- and 8-year overall survival rates were 87.5% and 84.2%, respectively; the 5- and 8-year local control rates were 94.4% and 92.9%, respectively. At the last follow-up, 19 of 250 patients (7.6%) underwent enucleation, 15 caused by local recurrence and 4 caused by AEs. Secondary glaucoma grades 1, 2, and 3 to 4 were observed in 22 (8.8%), 49 (19.6%), and 5 (2.0%) of patients, respectively. At the last follow-up, ≥ effective VA, ≥ counting fingers, and ≥ LP were maintained in 80 (33%), 120 (49%), and 154 (63%) of patients, respectively. Preservation rate of ≥ LP vision at 5 and 8 years after CIRT was 65.7% and 55.3%, respectively.CIRT for CMM is a promising treatment for both tumor control and preservation of the eye and VA.