脉络膜转移癌的治疗

Treatment of choroidal metastases

目的 探讨脉络膜转移癌的临床特征及治疗。方法 回顾性分析的 14例脉络膜转移癌病例中 ,来源于肺癌 7例、乳腺癌 5例、肝癌 1例、宫颈癌 1例。 14例中眼球摘除术 3例 ,单纯放射治疗 5例 ,化疗后放射治疗 2例 ,全身化疗 4例。放射治疗采用60 Co或直线加速器常规照射 ;全身化疗分别采用COMVP ,PAF及PAMF方案。结果 经放射治疗 7例 8只眼 ,6只眼视力好转 ;全身化疗 4例 ,3例视力好转 ,其中 2例乳腺癌来源的分别于治疗后 2个月及 3个月后视力再次下降。 14例中除 1例仍生存外 ,余 13例均死于全身广泛转移 ,其生存时间 6～ 2 7个月 ,中位生存时间 10个月。结论 放射治疗是一种有效的并且安全的姑息治疗脉络膜转移癌的手段 ,并能保存视力 ,提高生存质量 ;建议放射治疗剂量在DT35Gy以上。

Objective To study the clinical features and treatment of choroidal metastases. Methods From April 1963 to September 1998, 14 patients were treated. The primary tumors were breast cancer 5 (36%), lung cancer 7 (50%), liver cancer 1 (7%) and cervix cancer 1 (7%). Three patients were treated with enucleation of eye, 5 with radiotherapy alone,2 with chemotherapy followed by radiotherapy,4 patients with chemotherapy alone. Results Except 3 patients with operation, 12 eyes of 11 cases evaluated, 10 eyes of 9 cases were improved in vision, complete response (CR) rate and partial response (PR) rate were 50% and 33% respectively, no change (NC) 16%. Visual acuity was improved in 6 eyes with EBRT. There were CR in 1 (9%) and PR in 2 (18%) with chemotherapy, but two cases of them recurred 2～3 months after chemotherapy. Only one case still alive, the other 13 cases died of widespread metastases. Conclusions Radiation therapy is an efficient palliative treatment for choroidal metastases and it helps the preservation of vision. Doses higher than 35 ?Gy are suggested.