title: Salvage proton beam therapy in local recurrent uveal melanoma.
abstract: OBJECTIVE
  To evaluate survival and ocular outcome in recurrent uveal melanoma treated with proton beam therapy as salvage therapy.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  We evaluated 48 patients with local recurrence of uveal melanoma after primary treatment with brachytherapy, transpupillary thermotherapy, proton beam therapy, laser photocoagulation, CyberKnife radiation, or photodynamic therapy. All patients received proton beam therapy as a salvage therapy at the Helmholtz Zentrum Berlin between July 2000 and December 2010. Kaplan-Meier analysis was used to obtain survival rates.
  
  
  RESULTS
  The Kaplan-Meier estimator for local tumor control was 92.1% at 10 years after secondary treatment with proton beam therapy. Local recurrence developed in 3 patients; 1 of them underwent enucleation. During follow-up, 20.8% of the patients died (16.7% of metastasis, 4.1% of other causes or not specified). The most frequent surgical interventions were phacoemulsification (20.8%) and pars plana vitrectomy (10.4%). The Kaplan-Meier estimators were 77.4% for survival and 70.1% for the absence of metastasis 10 years after the primary treatment.
  
  
  CONCLUSIONS
  Proton beam therapy as a salvage treatment resulted in high local tumor control rates in recurrent uveal melanoma, especially if the primary therapy was transpupillary thermotherapy or plaque brachytherapy. Preservation of the globe was possible in most patients. Enucleations were indicated only in case of re-recurrences of uveal melanoma, but not because of secondary complications like intractable pain or secondary glaucoma. Retreatment was associated with vision deterioration, but loss of vision remained exceptional. Further larger prospective studies are needed to confirm the presented results of our retrospective analysis.
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany. Electronic address: aline-isabel.riechardt@charite.de.
authors.forename: Aline I
authors.initials: AI
authors.lastname: Riechardt
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Dino
authors.initials: D
authors.lastname: Cordini
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Bianca
authors.initials: B
authors.lastname: Dobner
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Ira
authors.initials: I
authors.lastname: Seibel
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Enken
authors.initials: E
authors.lastname: Gundlach
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Matus
authors.initials: M
authors.lastname: Rehak
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Hager
authors.affiliation: Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Stark
authors.affiliation: Klinik für Radioonkologie und Strahlentherapie, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Moser
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Joussen
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D061766:Proton Therapy / Q000379:methods*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D014604:Uveal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D000098943:Uveal Melanoma