伽玛刀治疗脉络膜黑色素瘤的中远期疗效分析

Middle and long term efficacy of Gamma knife radiotherapy for choroidal melanomas

目的评价伽玛刀治疗脉络膜黑色素瘤的中远期疗效。方法应用伽玛刀治疗脉络膜黑色素瘤病人13例,对中远期疗效进行随访。治疗计划:均采用4mm准直器,边缘剂量40Gy,中心剂量80Gy,等剂量线50%,等中心点1～8个。结果随访11～96个月,平均54个月。肿瘤有效控制12例,占92.3%;其中肿瘤体积不变4例,缩小8例。无效1例,肿瘤体积增大。随访期间出现晶状体浑浊和新生血管性青光眼各1例,未见远处转移及其他严重并发症发生。视力变化:改善4例,不变4例,下降3例,丧失2例。结论伽玛刀治疗脉络膜黑色素瘤既能控制肿瘤生长,又可在一定程度上保留病人视力,是一种有效的治疗方法。

Objective To evaluate the middle and long term efficacy of Gamma-knife treatment of malignant choroidal melanomas. Methods Thirteen patients with choroidal melanomas were treated by stereotactic radiosurgery with Gamma-knife. The therapy plan was as follows： peripheral dose of 40 Gy, central dose of 80 Gy, 50% isodose curve, and the isocenter point was 1 to 8. The 4 mm collimator was used in all the patients. Results During a median follow-up period of 54 months （ranged from 11 to 96 months）, effective tumor control was achieved in 12 cases （92.3%）, tumor volume was unchanged in 4 cases and tumor shrank in 8 cases. Tumor volume increased was seen in one patient. Lens opacity or neovascular glaucoma occurred in 1 case each, no distant metastasis and other severe complications occurred. Visual changes： improved in 4 cases, kept stable in 4, decreased in 3 and lost in 2. Conclusions Stereotactic radiosurgery by Gamma-knife is an effective therapy for malignant choroidal melanomas, and can both preserve the vision and control tumor growth.