title: Outcomes of proton therapy for the treatment of uveal metastases.
abstract: OBJECTIVE
  Radiation therapy can be used to treat uveal metastases with the goal of local control and improvement of quality of life. Proton therapy can be used to treat uveal tumors efficiently and with expectant minimization of normal tissue injury. Here, we report the use of proton beam therapy for the management of uveal metastases.
  
  
  METHODS
  A retrospective chart review was made of all patients with uveal metastases treated at our institution with proton therapy between June 2002 and June 2012. Patient and tumor characteristics, fractionation and dose schemes, local control, and toxicities are reported.
  
  
  RESULTS
  Ninety patients were identified. Of those, 13 were excluded because of missing information. We report on 77 patients with 99 affected eyes with available data. Patients were 68% female, and the most common primary tumor was breast carcinoma (49%). The median age at diagnosis of uveal metastasis was 57.9 years. Serous retinal detachment was seen in 38% of treated eyes. The median follow-up time was 7.7 months. The median dose delivered to either eye was 20 Gy(relative biological effectiveness [RBE]) in 2 fractions. Local control was 94%. The median survival after diagnosis of uveal metastases was 12.3 months (95% confidence interval, 7.7-16.8). Death in all cases was secondary to systemic disease. Radiation vasculopathy, measured decreased visual acuity, or both was observed in 50% of evaluable treated eyes. The actuarial rate of radiation vasculopathy, measured decreased visual acuity, or both was 46% at 6 months and 73% at 1 year. The 6 eyes with documented local failure were successfully salvaged with retreatment.
  
  
  CONCLUSIONS
  Proton therapy is an effective and efficient means of treating uveal metastases. Acutely, the majority of patients experience minor adverse effects. For longer-term survivors, the risk of retinal injury with vision loss increases significantly over the first year.
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Sophia C
authors.initials: SC
authors.lastname: Kamran
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: John M
authors.initials: JM
authors.lastname: Collier
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Lane
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kim
authors.affiliation: Division of Biostatistics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Niemierko
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Yen-Lin E
authors.initials: YL
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: John E
authors.initials: JE
authors.lastname: Munzenrider
authors.affiliation: Retina Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Gragoudas
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: hshih@partners.org.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Shih
mesh_terms: D001943:Breast Neoplasms; D002423:Cause of Death; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms; D008297:Male; D008875:Middle Aged; D061766:Proton Therapy / Q000191:economics / Q000379:methods*; D011879:Radiotherapy Dosage; D012160:Retina / Q000528:radiation effects; D012163:Retinal Detachment / Q000209:etiology; D012189:Retrospective Studies; D016019:Survival Analysis; D014604:Uveal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D014792:Visual Acuity / Q000528:radiation effects