title: Proton beam therapy for presumed and confirmed iris melanomas: a review of 36 cases.
abstract: BACKGROUND
  To report the clinical features and outcomes of iris melanomas treated by proton beam therapy.
  
  
  METHODS
  A retrospective study was conducted at the Croix-Rousse University Hospital of Lyon, Department of Ophthalmology, in 36 patients treated by proton beam therapy for presumed (n = 29) and confirmed (n = 7) iris melanomas between July 1997 and October 2010. Ciliary body melanomas with iris involvement were excluded. The patients' mean age was 54.4 years (range, 22-82 years). The average tumor diameter was 3.8 mm (range, 2.5-8.0). The iridocorneal angle was invaded by the tumor in 47% of cases (n = 17), the ciliary body in 17% of cases (n = 6), and the sclera in 3% (n = 1). Raised intraocular pressure was present before treatment in 11.1 % of cases (n = 4). Tumor biopsy was performed in 19% of cases (n = 7). Four patients had undergone an initial incomplete surgical excision of tumor before radiotherapy. Surgical preparation of the eye with tantalum ring positioning had been performed in all cases 3-4 weeks before irradiation. The prescribed dose was 60 Cobalt Gray Equivalent (CGE) of proton beam radiotherapy delivered in four fractions on four consecutive days.
  
  
  RESULTS
  The median follow-up was 50 months (mean 60.5, range 15-136). One patient (2.7%) was lost to follow-up. None of the patients showed tumor progression, local recurrence, or metastasis. None of the patients required secondary enucleation. Cataract was developed in 62% of patients, glaucoma in two cases (6%) after irradiation, and hyphema with the aggravation of pre-existing glaucoma in one patient. No patients developed neovascular glaucoma.
  
  
  CONCLUSIONS
  Proton beam therapy appears to be the treatment of choice for the conservative treatment of iris melanomas with excellent tumor control and an acceptable rate of complications. Longer follow-up studies on a larger series is necessary to consolidate these results.
authors.affiliation: Department of Ophthalmology, Croix-Rousse University Hospital, University Claude Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Rahmi
authors.forename: Hamid
authors.initials: H
authors.lastname: Mammar
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.forename: Gaelle
authors.initials: G
authors.lastname: Angellier
authors.forename: Joel
authors.initials: J
authors.lastname: Herault
authors.forename: Pierre
authors.initials: P
authors.lastname: Chauvel
authors.forename: Laurent
authors.initials: L
authors.lastname: Kodjikian
authors.forename: Philippe
authors.initials: P
authors.lastname: Denis
authors.forename: Jean Daniel
authors.initials: JD
authors.lastname: Grange
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005127:Eye Color; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015811:Iris Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D016896:Treatment Outcome; D055815:Young Adult