Survival and complications following Gamma Knife radiosurgery or enucleation for ocular melanoma: a 20-year experience

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• 作者：Eduard B. Dinca (1)
  John Yianni (1)
  Jeremy Rowe (1)
  Matthias W. R. Radatz (1)
  Daniel Preotiuc-Pietro (2)
  Paul Rundle (3)
  Ian Rennie (3)
  Andras A. Kemeny (1)
  
• 关键词：Gamma Knife ; Radiosurgery ; Ocular melanoma ; Enucleation
• 刊名：Acta Neurochirurgica
• 出版年：2012
• 出版时间：April 2012
• 年：2012
• 卷：154
• 期：4
• 页码：605-610
• 全文大小：243KB
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• 作者单位：Eduard B. Dinca (1)
  John Yianni (1)
  Jeremy Rowe (1)
  Matthias W. R. Radatz (1)
  Daniel Preotiuc-Pietro (2)
  Paul Rundle (3)
  Ian Rennie (3)
  Andras A. Kemeny (1)
  
  1. The National Centre for Stereotactic Radiosurgery, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, UK
  2. Department of Computer Science, University of Sheffield, Sheffield, UK
  3. Department of Ophtalmology, Royal Hallamshire Hospital, Sheffield, UK
  

文摘

Background We present our experience in treating ocular melanoma at the National Centre for Stereotactic Radiosurgery in Sheffield, UK over the last 20?years. Method We analysed 170 patients treated with Gamma Knife radiosurgery, recorded the evolution of visual acuity and complication rates, and compared their survival with 620 patients treated with eye enucleation. Different peripheral doses (using the 50% therapeutic isodose) were employed: 50-70?Gy for 24 patients, 45?Gy for 71 patients, 35?Gy for 62 patients. Findings There was no significant difference in survival between the 35-Gy, 45-Gy and 50-to 70-Gy groups when compared between themselves (p--.168) and with the enucleation group (p--.454). The 5-year survival rates were: 64% for 35?Gy, 62.71% for 45?Gy, 63.6% for 50-0?Gy and 65.2% for enucleated patients. Clinical variables influencing survival for radiosurgery patients were tumour volume (p--.014) and location (median 66.4 vs 37.36?months for juxtapapillary vs peripheral tumours, respectively; p--.001), while age and gender did not prove significant. Regarding complications, using 35?Gy led to more than a 50% decrease, when compared with the 45-Gy dose, in the incidence of cataract, glaucoma and retinal detachment. Retinopathy, optic neuropathy and vitreous haemorrhage were not significantly influenced. Blindness decreased dramatically from 83.7% for 45?Gy to 31.4% for 35?Gy (p--.006), as well as post-radiosurgery enucleation: 23.9% for 45?Gy vs 6.45% for 35?Gy (p--.018). Visual acuity, recorded up to 5?years post-radiosurgery, was significantly better preserved for 35?Gy than for 45?Gy (p--.0003). Conclusions Using 35?Gy led to a dramatic decrease in complications, vision loss and salvage enucleation, while not compromising patient survival.