脉络膜恶性黑色素瘤碳离子放射治疗后眼和视觉保存的长期结局
Long-Term Outcomes of Ocular and Visual Preservation After Carbon Ion Radiation Therapy for Choroidal Malignant Melanoma
影响因子:6.50000
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
摘要
这项研究旨在评估脉络膜恶性黑色素瘤（CMM）的碳离子辐射疗法（CIRT）的长期结果，尤其是在保护眼睛和视力（VA）的250例2003年1月至2021年9月之间用CIRT治疗的眼内局部CMM患者共有250例。剂量处方包括60至85 Gy/4至5 fr，从2018年开始使用68 Gy/4 FR。带有扫描光束的旋转龙门系统是在2018年4月引入的。根据AES的共同术语标准（版本5.0。）对不良事件（AES）进行了分级。对于继发性青光眼，与肿瘤相关的视野缺陷被排除在评估之外。对于VA，跟踪了245例VA≥光感（LP）的患者。有效的VA（≥20/200，Snellen等效），手指计数和LP用作指标。中位年龄为55（15-86）年。在16（6.4％），41（16.4％），189（75.6％）和4（1.6％）患者中观察到T类别1、2、3和4。中位随访为72.5个月，5年和8年的总生存率分别为87.5％和84.2％。 5年和8年的局部控制率分别为94.4％和92.9％。在最后一次随访中，250名患者中有19例（7.6％）接受了摘除次数，15例是由局部复发引起的，而AES引起的4例。在22（8.8％），49（19.6％）和5（2.0％）的患者中观察到了次生青光眼1、2和3至4年级。在最后一次随访中，分别在80（33％），120（49％）和154例（63％）的患者中维持≥10≥1和≥1的有效VA，≥LP。 CIRT后5年和8年的保存率分别为65.7％和55.3％。CMM的cirt是肿瘤控制和眼睛和VA保存的有前途的治疗方法。
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.