Conservation treatment of the eye: Conformal proton reirradiation for recurrent uveal melanoma.
OBJECTIVE
To evaluate the outcomes of a second course of proton beam radiation therapy (PBRT) in patients with recurrent uveal melanoma.


METHODS
Thirty-one patients received a second course of PBRT. The mean interval between the first and the second PBRT course was 50.2 months (range, 8-165 months). Most patients (87%) received 70 cobalt Gray equivalent (CGE) for both courses. Visual acuity was 20/200 or better in 30 patients initially and in 22 patients at the second treatment. The mean follow-up time after the second treatment was 50 months (range, 6-164 months).


RESULTS
At the time of the last follow-up, 20 patients were classified as having no evidence of disease, defined as tumor regression or an absence of tumor progression. Nine eyes (29%) were enucleated because of local recurrence (n = 5) or intractable pain (n = 4). The 5-year eye retention rate was 55% (95% confidence interval: 25.2-77.4). Six of the 22 patients who retained the eye (27%) had useful vision (20/200 or better).


CONCLUSIONS
A second course of PBRT for recurrent uveal melanoma to total doses between 118 and 140 CGE was associated with a relatively good probability of local control and a low enucleation rate. Although most patients lost vision, the majority were able to retain the reirradiated eye. Further evaluation is needed to assess metastasis-free survival of additional proton irradiation vs. enucleation after local recurrence.
Marucci
Laura
L
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
Lane
Anne M
AM
Li
Wenjun
W
Egan
Kathleen M
KM
Gragoudas
Evangelos S
ES
Adams
Judy A
JA
Collier
John M
JM
Munzenrider
John E
JE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D015353:Eye Enucleation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D061766:Proton Therapy; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011522:Protons
D011522:Protons