Proton radiation therapy for medium and large choroidal melanoma: preservation of the eye and its functionality.
OBJECTIVE
Evaluation of efficacy and safety of proton radiation therapy (PRT) for medium- and large-size choroidal melanoma with focus on preservation of the eye and its function.


METHODS
Retrospective review of 78 patients with 60 medium and 18 large-size choroidal melanomas at a median follow-up of 34 months.


RESULTS
The 5-year data for local control, metastases-free survival, and disease-specific survival were estimated to be 90.5 +/- 3.7%, 76.2 +/- 6.7%, and 75.6 +/- 7.6%, respectively. Eye preservation was achieved in 75.3% of patients, with useful (better than 20/200) visual acuity (VA) in 49.1% of surviving patients. Both local failure and complications led to enucleation. Prognosticators were tumor close to the optic disc (p = 0.003), large tumors involving the ciliary body (p = 0.041), and local failure (p < 0.001). Prognostic factors for VA following PRT were initial VA (p = 0.001), doses to optic disc (p = 0.001) and fovea (p = 0.022) higher than 35 CGE (Cobalt Gray equivalent), tumor close to the optic disc (p = 0.034), and retinal detachment (p < 0.001). Tumor basis diameter was significantly related to metastases free survival (p = 0.02), overall survival (p = 0.033), and disease specific survival (p = 0.017), but did not impair local tumor control, rate of enucleation, and VA.


CONCLUSIONS
The present data suggest that PRT is an effective and safe treatment for medium and large size choroidal melanoma. PRT can preserve the eye and its function in a reasonable percentage of patients. Further evaluation in controlled clinical trials comparing PRT to plaque radiotherapy and enucleation is required.
Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. mfuss@saci.org
M
M
Fuss
L N
LN
Loredo
P A
PA
Blacharski
R I
RI
Grove
J D
JD
Slater
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D011379:Prognosis; D061766:Proton Therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D014792:Visual Acuity; D011522:Protons
D011522:Protons