title: Proton beam therapy leads to excellent local control rates in choroidal melanoma in the intermediate fundus zone.
abstract: OBJECTIVE
  To evaluate long-term outcomes of proton beam radiotherapy in the treatment of choroidal melanoma of the intermediate zone of the fundus.
  
  
  METHODS
  Retrospective interventional single-center study.
  
  
  METHODS
  The study was a retrospective analysis with long-term follow-up of 62 patients with a minimum tumor-to-disc and tumor-to-fovea distance of 2 mm of choroidal melanoma in the intermediate zone of the fundus. Mean values of tumor prominence, largest basal diameter, and tumor distances to the optic disc and fovea were 7.6, 12.8, 5.2, and 4.6 mm, respectively. All patients were irradiated with a total proton dose of 60 cobalt gray equivalents.
  
  
  RESULTS
  After proton beam radiotherapy, 71.0% of the patients received subsequent endoresection of the tumor. Only 18 patients (29.0%) did not require additional tumor resection and were analyzed as a separate group. For the total of patients, the median follow-up time was 70.3 months. The 5-year Kaplan-Meier rates of local tumor relapse, enucleation, and distant metastasis were 3.9%, 3.7%, and 13.4%, respectively. Cataract surgery was the most frequent secondary treatment in our cohort.
  
  
  CONCLUSIONS
  In this study we demonstrate the effectiveness of proton beam irradiation in tumor control and preservation of the globe in the analyzed patients. The rate of metastasis was not higher than previously described. Nevertheless, consecutive tumor surgery is frequently required to maintain the eye in patients with large-sized choroidal melanomas. In conclusion, proton beam radiotherapy allows preservation of the eye in mid-zone choroidal melanomas.
authors.affiliation: Department of Ophthalmology, Charité Campus Benjamin Franklin, Berlin, Germany. Electronic address: shideh.schoenfeld@charite.de.
authors.forename: Shideh
authors.initials: S
authors.lastname: Schönfeld
authors.affiliation: Department of Ophthalmology, Charité Campus Benjamin Franklin, Berlin, Germany; Berlin Protonen, Helmholtz-Zentrum Berlin für Materialien und Energie, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Dino
authors.initials: D
authors.lastname: Cordini
authors.affiliation: Department of Ophthalmology, Charité Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Aline I
authors.initials: AI
authors.lastname: Riechardt
authors.affiliation: Department of Ophthalmology, Charité Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Ira
authors.initials: I
authors.lastname: Seibel
authors.affiliation: Department of Ophthalmology, Charité Campus Benjamin Franklin, Berlin, Germany; Clinic of Ophthalmology, DRK Kliniken Westend, Berlin, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Willerding
authors.affiliation: Department of Ophthalmology, University of Innsbruck, Innsbruck, Austria.
authors.forename: Nikolaos E
authors.initials: NE
authors.lastname: Bechrakis
authors.affiliation: Department of Oncology and Radiotherapy, Charité Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Moser
authors.affiliation: Department of Ophthalmology, Charité Campus Benjamin Franklin, Berlin, Germany.
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Joussen
mesh_terms: D000328:Adult; D000368:Aged; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D061766:Proton Therapy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016896:Treatment Outcome