- 期刊
Gamma Knife Perfexion Radiosurgery for Intraocular Tumor-Technique Establishment and Preliminary Results
加馬刀(Perfexion)於眼球內腫瘤之應用－技術建立與初步結果
摘要
目的：放射線手術用於治療眼球內腫瘤對於保留視力與眼球保存佔有重要的角色，與近接治療相比，用於葡萄膜黑色素瘤病人，放射線手術亦提供了一個非侵入性與單次之治療方式。此外放射線手術之適應症可用於其他眼球內疾病。此篇研究主要為評估新設計之加馬刀治療方法及流程，用於眼球內腫瘤之定位準確性與臨床結果。材料與方法： 選擇2位葡萄膜黑色素瘤病人與1位乳癌併眼球內轉移之病人接受加馬刀（Perfexion）治療。病人先接受球後麻醉，並將兩條眼球外肌肉縫合固定於頭部立體定位框架上，做為眼球之固定，之後安排磁振造影掃描以製作加馬刀計畫。單次治療處方劑量為25-30 Gy，治療計畫選擇50-55%的等劑量曲線範圍包覆靶體積。病人分別於固定頭架之後（CT-1），治療之前（CT-2），及治療之後（CT-3）共會掃描三組電腦斷層，藉此比較腫瘤之體積，腫瘤與水晶體之重心位置與位移，來分析定位之準確性。結果：眼球移動分析結果，在三組電腦斷層影像CT-1 、CT-2 、CT-3 上，腫瘤與水晶體之重心位置位移均小於0.120公厘，在給予劑量的腫瘤包覆率均高於95%。在三位病人的追蹤中可見腫瘤體積之縮小與視網膜剝離之改善。結論：根據本研究加馬刀手術之治療方法與流程，加馬刀運用於眼球內腫瘤治療具有高準確性。加馬刀可提供眼球內腫瘤非侵入性及單次治療之器官保留治療方式。
並列摘要
Purpose: Radiosurgery plays an important role in treating patients with intraocular tumor and retained visual function aiming at organ-conservation. Gamma knife stereotactic radiosurgery (GKRS) provides a relatively non-invasive and less time-consuming procedure for treating patients with choroidal melanoma comparing with plaque brachytherapy. It also has the potential radiosurgery to provide effective treatment for other ophthalmologic indication. We presented a new treatment protocol using GKRS to treat patient with intraocular tumor and evaluated the safety and precision of GKRS as a primary treatment for intraocular tumor.Methods: Two patients with uveal melanoma and one patient with breast cancer orbital metastasis treated with the Leksell Gamma Knife Perfexion stereotactic radiosurgery in our hospital. Retrobulbar anesthesia following fixation of the treated eye by suturing two extraocular muscles to the stereotactic frame were performed in order to immobilize the eye in the whole treatment procedure. The dose to the tumor margin was 25-30 Gy prescribed at 50-55% isodose line. Contrast-enhanced MRI was used for Gamma Plan dose planning. CT scans were done after eye fixation, immediate before and after the GKRS to confirm the accuracy of tumor localization. We compared tumor volume, tumor and lens gravity point deviation, and tumor coverage in the 3 sets of CT scans to check the precision of immobilization and eye fixation.Results: The eye movement analysis revealed that the gravity point coordination deviation of the tumor and lens between CT-1 and CT-2, or CT-1 and CT-3 was less than 0.120 mm. At least 95% of the tumor volume was covered by the prescription dose in the 3 sets of CT image. After GKRS, tumor shrinkage and serous retinal detachments disappearance were noted by ophthalmoscopy and orbital MRI in two patients. No major complication was found during follow up.Conclusion: GKRS using our treatment protocol is a relatively non-invasive, organconserving, and less time-consuming single fraction treatment for intraocular tumor. Our eye fixation method reveals high accuracy. Larger study with long term follow up is needed to evaluate the dose response result of the patients.
延伸閱讀
- 陳雅婷（2017）。加馬刀治療腦膜瘤病人的資源使用及臨床效果：與傳統開顱手術比較〔碩士論文，高雄醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0011-3007201716325100
- Wu, J. C., Lin, M. S., Hsieh, H. L., Lin, T. C., Chen, C. C., & Lin, E. (2006). 比較雙極電刀及單極電刀在治療良性攝護腺增生的內視鏡刮除手術其效能與安全性－初步報告. 秀傳醫學雜誌, 6(3&4), 101-106. https://www.airitilibrary.com/Article/Detail?DocID=15610497-200610-6-3&4-101-106-a
- Chen, Y. H., Wu, W. C., Wang, N. K., Chen, T. L., Chao, A. N., Chen, K. J., Hwang, Y. S., Chen, Y. P., Liu, L., Kuo, J. Z. C., Chang, C. J., Chuang, L. H., & Lai, C. C. (2013). 合併光動力療法與眼內注射抗血管新生藥物治療多囊性脈絡膜病變之病患：一年之成效. 中華民國眼科醫學會雜誌, 52(1), 21-31. https://www.airitilibrary.com/Article/Detail?DocID=10213120-201304-201309060003-201309060003-21-31
- Lin, M. S., Wu, J. C. H., Hsieh, H. L., Lin, T. C., Chen, C. C., & Lin, E. (2006). 比較雙極電刀及單極電刀用於良性攝護腺增生的內視鏡刮除手術之效能與安全性：一年追蹤報告. Mid-Taiwan Journal of Medicine, 11(3), 143-148. https://doi.org/10.6558/MTJM.2006.11(3).1
- 謝智翔（2013）。隱馬可夫模型對手術切骨操作意圖之初步研究〔碩士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2013.10756