- 作者：Roman Dunavoelgyi ; M.D.&lowast ; ; Karin Dieckmann ; M.D.&dagger ; ; Andreas Gleiss ; Ph.D.&Dagger ; ; Stefan Sacu ; M.D.&lowast ; ; Karl Kircher ; M.D.&lowast ; ; Michael Georgopoulos ; M.D.&lowast ; ; Dietmar Georg ; Ph.D.&dagger ; ; Martin Zehetmayer ; M.D.&lowast ; ; martin.zehetmayer@meduniwien.ac.at ; Richard Poetter ; M.D.&dagger ;
- 关键词：Choroidal melanoma ; Hypofractionated stereotactic photon radiotherapy ; Adverse side effects ; Juxtapapillary tumors
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2012
- 出版时间：1 May, 2012
- 年：2012
- 卷：83
- 期：1
- 页码：121-128
- 全文大小：542 K
Purpose
To evaluate side effects of hypofractionated stereotactic photon radiotherapy for patients with choroidal melanoma.Patients and Methods
Two hundred and twelve patients with choroidal melanoma unsuitable for ruthenium-106 brachytherapy or local resection were treated stereotactically at the Medical University of Vienna between 1997 and 2007 with a Linac with 6-MV photon beams in five fractions with 10, 12, or 14 Gy per fraction. Examinations for radiogenic side effects were performed at baseline and every 3 months in the first 2 years, then every 6 months until 5 years and then once a year thereafter until 10 years after radiotherapy. Adverse side effects were assessed using slit-lamp examination, funduscopy, gonioscopy, tonometry, and, if necessary, fundus photography and fluorescein angiography. Evaluations of incidence of side effects are based on an actuarial analysis.
Results
One hundred and eighty-nine (89.2 % ) and 168 (79.2 % ) of the tumors were within 3 mm of the macula and the optic disc, respectively. The five most common radiotherapy side effects were retinopathy and optic neuropathy (114 cases and 107 cases, respectively), cataract development (87 cases), neovascular glaucoma (46 cases), and corneal epithelium defects (41 cases). In total, 33.6 % , 38.5 % , 51.2 % , 75.5 % , and 77.6 % of the patients were free of any radiation retinopathy, optic neuropathy, cataract, neovascular glaucoma, or corneal epithelium defects 5 years after radiotherapy, respectively.
Conclusion
In centrally located choroidal melanoma hypofractionated stereotactic photon radiotherapy shows a low to moderate rate of adverse long-term side effects comparable with those after proton beam radiotherapy. Future fractionation schemes should seek to further reduce adverse side effects rate while maintaining excellent local tumor control.