Осложнения лучевой терапии меланомы хориоидеи и возможности их лечения

Введение. Приоритетным направлением в лечении меланомы хориоидеи (МХ) являются органосохраняющие методы, среди которых ключевую роль занимает лучевая терапия. Несмотря на высокую эффективность, применение радиационного воздействия сопровождается развитием постлучевых осложнений, которые могут нивелировать результаты лечения и в некоторых ситуациях приводить к необходимости выполнения вторичной энуклеации.

Цель работы — обобщить данные современных исследований, посвященных лучевой терапии МХ, спектру и частоте возникающих постлучевых осложнений, факторам риска их развития, способам профилактики и лечения в зависимости от методики.

Материалы и методы. Литературный поиск и анализ научных публикаций проводился на русском и английском языках по ключевым словам. Критерии отбора публикаций: оригинальные статьи (рандомизированные и нерандомизированные клинические исследования), обзоры (метаанализы и систематические обзоры), соответствующие рассматриваемой теме.

Результаты и обсуждения. Обзор включает в себя изучение современных методов лучевой терапии МХ, таких как брахитерапия, протонная терапия и стереотаксическая радиохирургия, а также показаний к их применению и эффективности. Анализируются типы, частота и особенности возникающих постлучевых осложнений, в т. ч. повреждение кожи век и периорбитальной области, роговицы, хрусталика, макулы, зрительного нерва, вторичная глаукома и др., а также рассматриваются факторы риска возникновения этих осложнений, возможные методы их профилактики и лечения.

Заключение. После различных методов лучевой терапии МХ отмечается схожий спектр осложнений, однако частота их возникновения и преобладание определенных форм варьируются в зависимости от выбранной методики. Большинство изменений поддается лечению, однако неоваскулярная глаукома, склеромаляция и персистирующие трофические язвы роговицы могут потребовать вторичной энуклеации, что подчеркивает необходимость совершенствования профилактики, раннего выявления осложнений и разработки четких критериев отбора пациентов для органосохраняющего лечения МХ.

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