Purchase this article with an account.
A.M. Poothullil, I.K. Daftari, J.M. O'Brien; Large Uveal Melanomas and Proton Beam Radiotherapy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1553.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: Proton beam radiotherapy (PBRT) is well established as an eye-conserving treatment for uveal melanoma, particularly small and medium-sized tumors. We review our experience with PBRT for large uveal melanomas. Methods: Retrospective review of patients with large uveal melanomas, defined by tumor height greater than 5 mm or basal tumor dimension greater than 15 mm, treated with PBRT between March 1997 and May 2002. All patients had at least six months of follow-up. Outcomes measures included visual acuity, anterior segment complications (lash loss, keratopathy, cataract, neovascular glaucoma), posterior segment complications (vitreous hemorrhage, radiation retinopathy, radiation papillopathy), local failures, enucleation, metastases, and all-cause mortality. Results: Thirty-six patients met inclusion criteria. Mean tumor height was 7.4 mm and mean basal tumor dimension was 15.5 mm. Mean follow-up was 18.3 months; median, 12.2 months. Mean treatment age was 59.2 years. Twenty-four patients (67%) were male. The right eye was involved in 69%. Eleven percent of tumors involved the ciliary body while 53% of tumors where within 3mm of the optic nerve or fovea. Median dose was 56 Gy. At the time of treatment, 28 patients (78%) had initial visual acuity of 20/100 or better in the affected eye. Of those patients followed at least two years, 46% retained vision of 20/100 or better with an average loss of 3.4 lines of vision. Thirty-three percent experienced lash loss, 17 % had dry eye symptoms or keratopathy, 14% developed cataract and neovascular glaucoma (NVG) occurred in 19%. Vitreous hemorrhage was seen in one patient. There were no cases of radiation retinopathy or papillopathy. Three patients had tumor growth, occurring at 8,9, and 16 months and underwent enucleation. Five patients had enucleation for NVG. There were no metastases. Two patients died of non-melanoma related causes. Conclusions: PBRT provided local control in 92% with no metastases at 2 years and eye retention in 76%. Significant visual loss was mainly seen in patients with tumors posterior to the equator. NVG occurred in patients with greatest tumor thickness. Large uveal melanomas may be treated successfully with PBRT. Final visual acuity and tumor recurrence rates are comparable to other eye-sparing regimens for large tumors.
This PDF is available to Subscribers Only