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Celia Maschi, Jean-Pierre Caujolle, Pierre Gastaud; Conjunctival melanomas and proton beam therapy: results on 47 patients. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3990.
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Conjunctival melanomas are some rare neoplasias. After local excision the tumor often recurs instead of adjuvant therapies such as cryo-coagulation or radiotherapy. We present the technique and the preliminary results of the combination of surgery, cryotherapy and protontherapy for controlling extended conjunctival melanomas.
Since 1992, forty seven patients with conjunctival melanomas have benefited from surgical excision, cryotherapy and adjuvant protontherapy. We perform proton beam therapy for localisation with fornical or caruncular involvement, tumoral thickness over 1.5mm, the presence of primary acquired melanosis, diffuse and multifocal disease and involved margins on histopathologic examsA specific device delivering a beam of radiation allows localized radiation of the tumor area, thereby preserving the adjacent healthy structures: the beam passes through a semi-spherical individual compensator to adapt the range of the proton beam to the shape of the inner sclera and let the protons irradiate lids, conjunctiva and sclera. Two individual collimators are used to carve the proton beam.Conjunctival melanomas were treated using the following dose concept: a volume where microscopic disease was expected received 36 Gy in 6 fractions, a smaller "boost" volume at high risk was irradiated with additional 16 Gy in 2 fractions.
The average duration of follow-up care of these patients is of 27,3 mois months, 35 patients were monitored from a carcinologic point of view . Twelve patients (25,5%) presented with recurrence, nine of these eyes had had recurrent disease prior to PBI. Metastatic disease was diagnosed in four cases. Four patients died tumour-related. In one cases regional lymph nodes were invaded.As secondary complications, 17 patients (36,2%) suffered from dry syndrome, 8 patients (17%) were operated for post-radiational cataract, 19 patients (40,4%) have ciliarys alopecia, 3 (6,4%) had lacrymal tract stenosis and 3 (6,4%) were treated for unilateral glaucoma by monotherapy
The classical treatments don’t always lead to the tumor control of the conjunctival melanomas and the final treatment of these neoplasias remains very often enucleation or even exenteration. Proton irradiation offers the possibility to successfully treat advanced melanomas of the conjunctiva with acceptable side effects and can be considered as an alternative to traditional treatments.
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