title: Choroidal melanoma: does endoresection prevent neovascular glaucoma in patient treated with proton beam irradiation?
abstract: OBJECTIVE
  To evaluate the efficacy of endoresection after proton beam radiotherapy to prevent neovascular glaucoma (NVG) in patients treated for choroidal melanoma.
  
  
  METHODS
  From a series of 4,867 patients treated for choroidal melanoma were prospectively recorded in the database (Macro Infermed 3.075). One hundred and seventy-one patients presenting a tumor diameter >10 mm and thickness >5 mm treated with proton beam (PB) radiotherapy were selected. One group of 63 patients was treated with PB therapy followed by endoresection (PE) of the scar. This group was compared with 2 historical matched controlled groups: 57 patients treated with PB therapy alone (P) and 51 patients treated with PB therapy followed by transpupillary thermotherapy of the scar (PTTT). Main outcome measures are as follows: age, gender, tumor diameter, tumor thickness, pre- and posttreatment visual acuity, NVG rate, secondary enucleation rate, and 5-year survival. Statistical analysis was performed using R version 2.5.1 software.
  
  
  RESULTS
  Correlations between the 3 groups were P = 0.29 for age, P = 4.7×10 for tumor diameter, and P = 6.44×10 for tumor thickness. Comparison between the 3 groups showed that 2-year survival without secondary enucleation was 96.2% for PE, 88.8% for P, and 98% for PTTT (P = 0.203) (95% confidence interval). Two-year survival without NVG (95% confidence interval) was 92.7% (85.1-1.00) for PE, 54.6% for P, and 62.1% for PTTT (P = 0.0001). The difference between the endoresection (PE) group and the PB radiotherapy (P) and PB radiotherapy + TTT (PTTT) groups in terms of reduction of the NVG rate was statistically significant. Relative risk of developing NVG was calculated with the P group as reference, relative risk = 1. The relative risk of the PTTT group was 0.79 (20% reduction of the risk), and the relative risk of the PE group was 0.18 (82% reduction of the risk of developing NVG).
  
  
  CONCLUSIONS
  This study shows that endoresection of the necrotic scar after PB radiotherapy reduces the risk of NVG and secondary enucleation for selected choroidal melanoma patients.
authors.affiliation: Department of Ocular Oncology, Institut Curie, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Cassoux
authors.forename: Sylvia
authors.initials: S
authors.lastname: Cayette
authors.forename: Corine
authors.initials: C
authors.lastname: Plancher
authors.forename: Livia
authors.initials: L
authors.lastname: Lumbroso-Le Rouic
authors.forename: Christine
authors.initials: C
authors.lastname: Levy-Gabriel
authors.forename: Bernard
authors.initials: B
authors.lastname: Asselain
authors.forename: Xavier
authors.initials: X
authors.lastname: Sastre
authors.forename: Jérôme
authors.initials: J
authors.lastname: Couturier
authors.forename: Sandrine
authors.initials: S
authors.lastname: Arrufat
authors.forename: Sophie
authors.initials: S
authors.lastname: Piperno-Neumann
authors.forename: Remi
authors.initials: R
authors.lastname: Dendale
authors.forename: Phuc
authors.initials: P
authors.lastname: Lehoang
authors.forename: Laurence
authors.initials: L
authors.lastname: Desjardins
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002830:Choroid Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D002921:Cicatrix / Q000601:surgery; D005260:Female; D015355:Glaucoma, Neovascular / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D013508:Ophthalmologic Surgical Procedures; D061766:Proton Therapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014792:Visual Acuity; D055815:Young Adult