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맥락막종양에 대한 감마나이프 방사선수술의 단기 치료 효과

Short-term Effect of Gamma Knife Radiosurgery for a Choroidal Tumor

윤영희|이주용|김중곤|조영현|권도훈|여준형|김윤전|이고은
대한안과학회 (The Korean Ophthalmological Society)|2020.10|대한안과학회지 (Journal of The Korean Ophthalmological Society)|제61권 제10호|pp. 1156-1163

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Choroidal melanomaChoroidal metastasisGamma knife radiosurgery
주제분류안과학

초록

목적: 맥락막종양 환자에서 감마나이프 방사선수술의 효과와 안전성에 대해서 알아보고자 하였다. 대상과 방법: 2016년 1월부터 2019년 2월까지 맥락막종양을 진단받고 감마나이프 방사선수술을 받은 환자들 중 1개월 이상 추적 관찰이 가능하였던 8명, 10안을 대상으로 의무기록을 후향적으로 분석하였다. 결과: 대상 환자의 평균 연령은 57.9 ± 14.6세(32-83세)였으며, 맥락막 전이암이 6안, 맥락막흑색종이 4안이었다. 감마나이프 방사선수술 후 평균 추적 관찰 기간은 7.0 ± 4.3개월(2-13개월)이었고, 평균 누적 주변부 선량은 25.36 ± 7.35 Gy (16-45 Gy)이었다. 치료 전후의 자기공명영상검사상 10안 중 8안에서 종양의 크기가 감소하였으며, 이 중 5안에서 주관적인 증상의 호전이 관찰되었다. 1명의 환자에서 종양의 크기가 증가하였으나 새로운 병변이 관찰되지 않았다. 다른 1명의 환자는 종양의 크기에 변화를 보이지 않았으나 통증이 악화되어 안구적출술을 시행하였다. 종양의 평균 크기는 감마나이프 방사선수술 전 평균 최대직경 1.60 ± 0.37 cm에서 치료 후 1.22 ± 0.47 cm (p=0.004)로, 평균 최소직경 0.62 ± 0.27 cm에서 0.38 ± 0.35 cm로 감소하였다(p=0.031). 대상 환자의 추적 관찰 기간 동안 방사선 관련 망막병증, 시신경병증, 백내장 등의 합병증은 관찰되지 않았다. 결론: 감마나이프 방사선수술은 안와 자기공명영상에서 맥락막종양 확인이 가능한 병변인 경우에 종양의 크기 감소를 기대할 수 있고, 안구 보존을 기대할 수 있는 비교적 안전한 대체 치료 방법의 하나로 판단된다.

Abstract

Purpose: To evaluate the effectiveness and safety of treating choroidal melanoma and cancer that has metastasized to the choroid with gamma knife radiosurgery (GKR). Methods: We performed a retrospective chart review that included 10 eyes of eight patients with a diagnosis of choroidal tumors who underwent GKR between January 2016 and February 2019 and who had at least one month follow-up visit. Results: The mean patient age was 57.9 ± 14.6 years (range, 32-83 years). The choroidal tumor group included six choroidal metastases and four choroidal melanomas. The mean follow-up period after GKR was 7.0 ± 4.3 months (range, 2-13 months). The mean cumulative marginal dose was 25.36 ± 7.35 Gy (range, 16-45 Gy). Pre- and postoperative magnetic resonance imaging revealed a reduction in tumor volume in eight of the 10 eyes and five of them presented with improved visual symptoms. One patient showed increased tumor volume; however, a new choroidal lesion was not observed. Another patient showed no reduction in tumor size; however, the pain had worsened, and the eye was enucleated. The mean maximum tumor diameter decreased from 1.60 ± 0.37 cm before to 1.22 ± 0.47 cm after GKR (p = 0.004), and the mean minimum diameter decreased from 0.62 ± 0.27 cm before to 0.38 ± 0.35 cm after GKR (p = 0.031). No radiation-induced optic neuropathy, retinopathy, or cataracts was observed in any of the cases during the follow-up period. Conclusions: GKR was shown to be safe for choroidal lesions identified in orbital magnetic resonance imaging with a reduction in the size of choroidal tumors and eyeball preservation expected with this treatment approach.

참고문헌 (39)

  1. Jardel P, "Management of choroidal metastases", Cancer Treat Rev, 40, pp.1119~1128 (2014)
  2. Quirk BJ, "Photodynamic therapy (PDT)for malignant brain tumors--where do we stand?", Photodiagnosis Photodyn Ther, 12, pp.530~544 (2015)
  3. Barbazetto IA, "Treatment of choroidal melanoma using photodynamic therapy", Am J Ophthalmol, 135, pp.898~899 (2003)
  4. Ghodasra DH, "Photodynamic therapy for choroidal metastasis", Am J Ophthalmol, 161, pp.104~109.e92 (2016)
  5. Abrams MJ, "Brachytherapy vs. external beam radiotherapy for choroidal melanoma: survival and patterns-of-care analyses", Brachytherapy, 15, pp.216~223 (2016)
  6. Nag S, "The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas", Int J Radiat Oncol Biol Phys, 56, pp.544~555 (2003)
  7. Filì M, "Ruthenium-106 versus iodine-125 plaque brachytherapy of 571 choroidal melanomas with a thickness of ≥5.5 mm", Br J Ophthalmol, 104, pp.26~32 (2020)
  8. Song WK, "Clinicopathologic report of uveal melanoma with persistent exudative retinal detachment after Gamma Knife radiosurgery", Ophthalmologica, 224, pp.16~21 (2010)
  9. Kang DW, "Long-term results of Gamma Knife surgery for uveal melanomas", J Neurosurg, 117(Suppl), pp.108~114 (2012)
  10. Lee CS, "Association of high metabolic activity measured by positron emission tomography imaging with poor prognosis of choroidal melanoma", Br J Ophthalmol, 95, pp.1588~1591 (2011)
  11. Chen CJ, "Emerging treatments for choroidal metastases", Surv Ophthalmol, 56, pp.511~521 (2011)
  12. Wiegel T, "External beam radiotherapy of choroidal metastases--final results of a prospective study of the German Cancer Society(ARO 95-08)", Radiother Oncol, 64, pp.13~18 (2002)
  13. Nelson CC, "A histopathologic study of 716 unselected eyes in patients with cancer at the time of death", Am J Ophthalmol, 95, pp.788~793 (1983)
  14. Wiegel T, "Frequency of asymptomatic choroidal metastasis in patients with disseminated breast cancer : results of a prospective screening programme", Br J Ophthalmol, 82, pp.1159~1161 (1998)
  15. Kanthan GL, "Management of metastatic carcinoma of the uveal tract : an evidence-based analysis", Clin Exp Ophthalmol, 35, pp.553~565 (2007)
  16. Konstantinidis L, "Intraocular metastases--a review", Asia Pac J Ophthalmol(Phila), 6, pp.208~214 (2017)
  17. Singh AD, "Uveal melanoma : trends in incidence, treatment, and survival", Ophthalmology, 118, pp.1881~1885 (2011)
  18. Lund RW, "The Collaborative Ocular Melanoma Study, mortality by therapeutic approach, age and tumor size", J Insur Med, 43, pp.221~226 (2013)
  19. Simonová G, "Leksell Gamma Knife treatment of uveal melanoma", J Neurosurg, 97, pp.635~639 (2002)
  20. Fakiris AJ, "Gamma-knife-based stereotactic radiosurgery for uveal melanoma", Stereotact Funct Neurosurg, 85, pp.106~112 (2007)
  21. Shah SU, "Uveal metastasis from lung cancer : clinical features, treatment, and outcome in 194patients", Ophthalmology, 121, pp.352~357 (2014)
  22. Demirci H, "Uveal metastasis from breast cancer in 264 patients", Am J Ophthalmol, 136, pp.264~271 (2003)
  23. Rudoler SB, "External beam irradiation for choroid metastases : identification of factors predisposing to long-term sequelae", Int J Radiat Oncol Biol Phys, 38, pp.251~256 (1997)
  24. Wen JC, "Ocular complications following I-125 brachytherapy for choroidal melanoma", Eye(Lond), 23, pp.1254~1268 (2009)
  25. Detorakis ET, "Iris and anterior chamber angle neovascularization after iodine 125 brachytherapy for uveal melanoma", Ophthalmology, 112, pp.505~510 (2005)
  26. Parsons JT, "Radiation retinopathy after external-beam irradiation : analysis of time-dose factors", Int J Radiat Oncol Biol Phys, 30, pp.765~773 (1994)
  27. Gupta A, "Radiation retinopathy : case report and review", BMC Ophthalmol, 7, pp.6~ (2007)
  28. Ares WJ, "Gamma knife radiosurgery for uveal metastases : report of three cases and a review of the literature", Am J Ophthalmol, 174, pp.169~174 (2017)
  29. Marchini G, "Gamma knife stereotactic radiosurgery of ocular metastases : a case report", Stereotact Funct Neurosurg, 64(Suppl 1), pp.67~71 (1995)
  30. Lally DR, "Regression of choroidal metastasis from breast carcinoma treated with Gamma knife radiosurgery", JAMA Ophthalmol, 132, pp.1248~1249 (2014)
  31. Zehetmayer M, "Stereotactic irradiation of uveal melanoma with the Leksell gamma unit", Front Radiat Ther Oncol, 30, pp.47~55 (1997)
  32. Zehetmayer M, "Local tumor control and morbidity after one to three fractions of stereotactic external beam irradiation for uveal melanoma", Radiother Oncol, 55, pp.135~144 (2000)
  33. Devin F, "Treatment of choroid melanoma by Gamma-Knife radiosurgery", J Fr Ophtalmol, 19, pp.551~554 (1996)
  34. Vavvas D, "Posterior uveal melanoma in young patients treated with proton beam therapy", Retina, 30, pp.1267~1271 (2010)
  35. Peeters A, "How costly is particle therapy? Cost analysis of external beam radiotherapy with carbon-ions, protons and photons", Radiother Oncol, 95, pp.45~53 (2010)
  36. Mueller AJ, "Stereotactic radiosurgery of large uveal melanomas with the gamma-knife", Ophthalmology, 107, pp.1381~1388 (2000)
  37. Zehetmayer M, "Suction attachment for stereotactic radiosurgery of intraocular malignancies", Ophthalmologica, 208, pp.119~121 (1994)
  38. Langmann G, "Gamma knife radiosurgery for uveal melanomas : an 8-year experience", J Neurosurg, 93(Suppl 3), pp.184~188 (2000)
  39. Danesh-Meyer HV, "Radiation-induced optic neuropathy", J Clin Neurosci, 15, pp.95~100 (2008)

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