title: Transpalpebral proton beam radiotherapy of choroidal melanoma.
abstract: BACKGROUND
  Collateral damage to upper eyelid margin during proton beam radiotherapy (PBR) for choroidal melanoma may cause squamous metaplasia of the tarsal conjunctiva with keratinisation, corneal irritation, discomfort and, rarely, corneal perforation. We evaluated transpalpebral PBR as a means of avoiding collateral damage to the upper eyelid margin without increasing the risk of failure of local tumour control.
  
  
  METHODS
  Retrospective study of consecutive patients who underwent PBR for choroidal melanoma between 1992 and 2007 at the Royal Liverpool University Hospital and the Douglas Cyclotron at Clatterbridge Cancer Centre, UK.
  
  
  RESULTS
  Sixty-three patients were included in this study. Mean basal tumour diameter and tumour thickness were 11.8 mm and 3.6 mm, respectively. PBR mean beam range and modulation were 26.5 mm and 16.9 mm respectively. The eyelid margin was included in the radiation field in 15 (24%) eyes. The median follow-up was 2.5 years. Local tumour recurrence developed in 2 (3.2%) patients. In these two cases that developed tumour recurrence the transpalpebral treatment did not involve the eyelid margin. Six (9.5%) patients died of metastatic disease. No eyelid or ocular surface problems developed in any of the 48 patients who were treated without eyelid rim involvement, while 7 of the 15 patients with unavoidable irradiation of the eyelid rim developed some degree of madarosis. These seven patients all received more than 26.55 proton Gy to the eyelid margin. Symptoms, such as grittiness occurred in 12% of 48 patients without eyelid margin irradiation as compared with 53% of 15 patients whose lid margin was irradiated.
  
  
  CONCLUSIONS
  Transpalpebral PBR of choroidal melanoma avoids eyelid and ocular surface complications without increasing failure of local tumour control.
authors.affiliation: Vitreoretinal and Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Lazaros
authors.initials: L
authors.lastname: Konstantinidis
authors.affiliation: Liverpool Ocular Oncology Research Group, Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
authors.forename: Dawn
authors.initials: D
authors.lastname: Roberts
authors.affiliation: Douglas Cyclotron, Clatterbridge Cancer Centre, Wirral, UK.
authors.forename: R Douglas
authors.initials: RD
authors.lastname: Errington
authors.affiliation: Douglas Cyclotron, Clatterbridge Cancer Centre, Wirral, UK.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kacperek
authors.affiliation: Vitreoretinal and Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Heimann
authors.affiliation: Ocular Oncology Service, Departments of Ophthalmology and Radiation Oncology, University of California, San Francisco, USA.
authors.forename: Bertil
authors.initials: B
authors.lastname: Damato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002830:Choroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005142:Eyelid Neoplasms / Q000209:etiology / Q000517:prevention & control*; D005143:Eyelids / Q000528:radiation effects; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D061766:Proton Therapy / Q000009:adverse effects / Q000379:methods*; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate; D014792:Visual Acuity; D055815:Young Adult
keywords: Choroid; Eye Lids; Neoplasia; Treatment other