葡萄膜黑色素瘤质子治疗初步总结  

Preliminary outcomes of proton radiotherapy for uveal melanoma

作　　者：岳晗 韩宜男[1,2,3] 任慧 徐彬彬[1,2,3] 万凌光 戈沁[1] 薛康 钱江 YUE Han;HAN Yinan;REN Hui;XU Binbin;WAN Lingguang;GE Qin;XUE Kang;QIAN Jiang(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;NHC Key Laboratory of Myopia(Fudan University)Shanghai 200031,China;Shanghai Key Laboratory of Visual Impairment and Restoration,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031 [2]国家卫生健康委员会近视眼重点实验室(复旦大学),上海200031 [3]上海市视觉损害与重建重点实验室,上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第2期150-157,165,共9页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：上海市科学技术委员会基金项目(20Y11911200)。

摘　　要：目的评估葡萄膜黑色素瘤患者接受质子治疗后初期的有效性和并发症。方法前瞻性分析我院自2015年1月~2020年6月,于国外接受质子治疗的患者,收集其基本信息,随访肿瘤大小、视力、并发症等,并进行评估。结果共11例患者接受质子放疗,平均随访(30.3±10.8)个月,其中男性5例、女性6例,平均年龄为(47.5±14.9)岁。肿瘤最大基底直径平均为(10.8±3.4)mm,平均厚度为(6.6±2.4)mm,其中有3例肿瘤累及睫状体。按TNM分期,有2例T1期、5例T2期、4例T3期。经过质子治疗,瘤体厚度较治疗前平均缩小(22.4±34.7)%,直径平均缩小(17.3±31.1)%。与术前相比,术后视力持平及提高者共3例。术后并发症中白内障及渗出性视网膜脱离各5例,皮肤损伤及睫毛缺失、青光眼、黄斑病变及玻璃体混浊各3例,干眼、角膜损伤和放射性视神经病变各1例。大部分并发症通过局部用药及手术治疗得到较明显改善;1例因持续性高眼压及视力丧失行眼球摘除术,1例因肝转移死亡,9例病情稳定。结论质子治疗葡萄膜黑色素瘤,不仅保眼率高,还能挽救部分有效视力,具有良好的应用前景;眼内抗血管内皮生长因子注射及其他综合治疗可有效改善术后并发症情况,其长远的治疗效果有待进一步观察。Objective To evaluate the preliminary outcomes of proton radiotherapy for uveal melanoma patients.Methods Clinical data,tumor size,vision acuity,complications of our patients treated by proton radiotherapy abroad from January 2015 to June 2020 were analyzed prospectively.Results Five male and six female patients received proton radiotherapy with a mean follow up of(30.3±10.8)months.The average age was(47.5±14.9)years.The mean largest basal tumor diameter and mean tumor thickness were(10.8±3.4)mm and(6.6±2.4)mm,respectively.Ciliary body involvement was observed in 3 cases.For TNM stages,2 cases were in stage T1,5 in T2 and 4 in T3.After proton radiotherapy,tumors reduced(22.4±34.7)%in the thickness and(17.3±31.1)%in the diameter.The vision acuity kept fair or got improved in 3 cases than before.For the complications,5 cases developed cataract and exudative retinal detachment respectively,and 3 cases developed glaucoma,skin damage with loss of eyelashes,maculopathy and vitreous opacity,respectively.Most complications could be treated by eye drops or surgeries.One received enucleation for durative intraocular hypertension with loss of vision;and one detected liver metastasis and died 21 months after radiotherapy;other nine patients all kept local and systemic stable.Conclusions Proton therapy for uveal melanoma can preserve both eyeball and visual acuity,with promising prospect.Intraoular anti vascular endothelial growth factor and other combined therapy can improve the postoperative complications effectively,however,the long-term therapeutic effect remains to be further studied.

关 键 词：葡萄膜黑色素瘤 质子 放射治疗 预后 

分 类 号：R739.7[医药卫生—肿瘤]