title: Uveal melanoma recurrence after fractionated proton beam therapy: comparison of survival in patients treated with reirradiation or with enucleation.
abstract: OBJECTIVE
  To retrospectively compare survival in recurrent uveal melanoma, between patients treated by enucleation or by a second course of fractionated proton beam therapy (PBT).
  
  
  METHODS
  Tumor recurrence was documented in 73 patients treated with PBT for uveal melanoma. Of the patients, 31 received a second course of PBT and 42 underwent enucleation. The mean patient age was 56 and 61 years for those undergoing enucleation and those undergoing reirradiation, respectively. Both primary and recurrent tumors were larger in patients undergoing enucleation. Tumor location and the presence or absence of ciliary body involvement did not differ significantly between the groups. The median follow-up after enucleation and after re-treatment was 79 and 59 months, respectively. Cumulative rates of outcomes and differences in rates between the reirradiated and enucleation groups were calculated by the Cox proportional hazards model and the log-rank test, respectively.
  
  
  RESULTS
  The median survival duration in the enucleated and reirradiated groups was 42 and 90 months, respectively. The median time free of metastases was 38 months in enucleated patients and 97 months in reirradiated patients. At 5 years after enucleation and after reirradiation, the probability of overall survival was 36% and 63%, respectively (p=0.040, log-rank test); the probability of freedom from metastases was 31% and 66%, respectively (p=0.028, log-rank test). These differences persisted after adjustment for recurrent tumor largest diameter and volume at the time of reirradiation or enucleation.
  
  
  CONCLUSIONS
  This retrospective analysis suggests that survival in reirradiated patients is not compromised by administration of a second course of PBT for recurrent uveal melanoma.
authors.affiliation: Department of Radiation Oncology, Regina Elena Research Institute, Rome, Italy. marucci_laura@yahoo.com
authors.forename: Laura
authors.initials: L
authors.lastname: Marucci
authors.forename: Marek
authors.initials: M
authors.lastname: Ancukiewicz
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lane
authors.forename: John M
authors.initials: JM
authors.lastname: Collier
authors.forename: Evangelos S
authors.initials: ES
authors.lastname: Gragoudas
authors.forename: John E
authors.initials: JE
authors.lastname: Munzenrider
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015353:Eye Enucleation / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D016016:Proportional Hazards Models; D061766:Proton Therapy; D019233:Retreatment / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D000098943:Uveal Melanoma; D011522:Protons
chemical_list: D011522:Protons