title: Proton beam radiotherapy of diffuse iris melanoma in 54 patients.
abstract: BACKGROUND
  Treatment modalities in iris melanoma include excision, plaque radiotherapy, photon or proton beam therapy and enucleation. In extensive tumours and diffuse seeding, radiotherapy remains as an alternative to enucleation.
  
  
  METHODS
  This study is a retrospective, consecutive, interventional, single-institutional case series. 54 patients with a diffuse and non-resectable iris melanoma diagnosed from September 1998 to June 2012 were included. A 68-megaelectron volt proton beam was used to treat the anterior segment with a total dose of 4×12.5 cobalt grey equivalent. The cases were evaluated for local tumour control, eye retention, functional outcome and local complications after treatment.
  
  
  RESULTS
  During a mean follow-up of 62.7 months (median 54.8 months, range 5.5-159.6 months), local tumour control was achieved in 96.3% of the patients. Cataract and glaucoma were the main complications developing after irradiation in 42.6% and 55.6%, respectively. In 34 of 44 patients (77.3%) who underwent cataract removal, a visual acuity of 20/40 or better following surgery was preserved. Enucleation was performed in three patients. The reason was suspected tumour recurrence in one and glaucoma in two. Hepatic metastasis occurred in one patient.
  
  
  CONCLUSIONS
  As an alternative to enucleation, whole anterior segment fractionated proton beam radiotherapy offered excellent local tumour control in diffuse iris melanoma. Given the limited alternatives, the rate of complications appears acceptable and visual function could be preserved in the majority of the patients during follow-up.
authors.affiliation: Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Gregor D
authors.initials: GD
authors.lastname: Willerding
authors.affiliation: Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Dino
authors.initials: D
authors.lastname: Cordini
authors.affiliation: Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hackl
authors.affiliation: Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Karle
authors.affiliation: Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Nona
authors.initials: N
authors.lastname: Lakotka
authors.affiliation: Department of Ophthalmology, DRK Kliniken Westend, Berlin, Germany.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Foerster
authors.affiliation: Department of Ophthalmology, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Nikolaos N
authors.initials: NN
authors.lastname: Bechrakis
authors.affiliation: Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Heufelder
authors.affiliation: Berlin Protonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Moser
authors.affiliation: Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Joussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000209:etiology / Q000628:therapy; D002648:Child; D015353:Eye Enucleation; D005260:Female; D018463:Filtering Surgery; D005500:Follow-Up Studies; D005901:Glaucoma / Q000209:etiology / Q000601:surgery; D006801:Humans; D015811:Iris Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D018918:Phacoemulsification; D011183:Postoperative Complications; D061766:Proton Therapy / Q000009:adverse effects; D011832:Radiation Injuries / Q000209:etiology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
keywords: Iris; Neoplasia