Eye retention after proton beam radiotherapy for uveal melanoma.
OBJECTIVE
To analyze the long-term results of eye retention after conservative treatment of uveal melanoma with proton beam radiotherapy, and to analyze the causes leading to enucleation after this conservative treatment approach.


METHODS
This was a prospective, noncomparative, interventional, consecutive case series. A total of 2645 patients (2648 eyes) with uveal melanoma were treated between 1984 and 1999 with proton beam radiotherapy. Data were analyzed as of February 2001. Patients' age ranged from 9 to 90 years, 1284 were men, and 1361 were women. Largest tumor diameter ranged from 4 to 27.5 mm, and tumor height from 0.9 to 15.6 mm. Median follow-up time was 44 months.


RESULTS
The overall eye retention rate at 5, 10, and 15 years after treatment was 88.9%, 86.2%, and 83.7%, respectively. In total, 218 eyes had to be enucleated. Enucleation was related to larger tumor size, mainly tumor height, proximity of posterior tumor margin to optic disc, male gender, high intraocular pressure, and large degree of retinal detachment at treatment time. After optimization of the treatment technique, the eye retention rate at 5 years was increased from 97.1% to 100% for small tumors, from 86.7% to 99.7% for medium, and from 71.1% to 89.5% for large tumors.


CONCLUSIONS
The treatment technique as used today results in excellent eye retention rates, even in less favorable cases such as large tumors and tumors located close to the optic disc. The experience and a continuous quality control program allowed us to improve the 5-year eye retention rate for all tumor sizes. These findings demonstrate the positive impact of experience and quality control-based efforts for treatment technique optimization.
Egger
Emmanuel
E
Division of Radiation Medicine, Paul Scherrer Institute, Villigen, Switzerland. EmmanuelEgger@psi.ch
Zografos
Leonidas
L
Schalenbourg
Ann
A
Beati
Donata
D
Böhringer
Terence
T
Chamot
Line
L
Goitein
Gudrun
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D018572:Disease-Free Survival; D015353:Eye Enucleation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009898:Optic Disk / Q000033:anatomy & histology; D016016:Proportional Hazards Models; D061766:Proton Therapy; D012163:Retinal Detachment / Q000150:complications; D012737:Sex Factors; D014604:Uveal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D014792:Visual Acuity; D011522:Protons
D011522:Protons