title: Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma.
abstract: OBJECTIVE
  To present our experience of the use of stereotactic radiosurgery and proton beam therapy to treat posterior uveal melanoma over a 10 year period.
  
  
  METHODS
  Case notes of patients treated with stereotactic radiosurgery (SRS), or Proton beam therapy (PBT) for posterior uveal melanoma were reviewed. Data collected included visual acuity at presentation and final review, local control rates, globe retention and complications. We analysed post-operative visual outcomes and if visual outcomes varied with proximity to the optic nerve or fovea.
  
  
  RESULTS
  191 patients were included in the study; 85 and 106 patients received Stereotactic radiosurgery and Proton beam therapy, respectively. Mean follow up period was 39 months in the SRS group and 34 months in the PBT group. Both treatments achieved excellent local control rates with eye retention in 98% of the SRS group and 95% in the PBT group. The stereotactic radiosurgery group showed a poorer visual prognosis with 65% losing more than 3 lines of Snellen acuity compared to 45% in the PBT group. 33% of the SRS group and 54% of proton beam patients had a visual acuity of 6/60 or better.
  
  
  CONCLUSIONS
  Stereotactic radiosurgery and proton beam therapy are effective treatments for larger choroidal melanomas or tumours unsuitable for plaque radiotherapy. Our results suggest that patients treated with proton beam therapy retain better vision post-operatively; however, possible confounding factors include age, tumour location and systemic co-morbidities. These factors as well as the patient's preference should be considered when deciding between these two therapies.
authors.affiliation: Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Sikuade
authors.affiliation: Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: S
authors.initials: S
authors.lastname: Salvi
authors.affiliation: Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Rundle
authors.affiliation: Department of Oncology, Douglas Cyclotron, Clatterbridge Cancer Centre, Wirral, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Errington
authors.affiliation: Department of Oncology, Douglas Cyclotron, Clatterbridge Cancer Centre, Wirral, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kacperek
authors.affiliation: Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: I G
authors.initials: IG
authors.lastname: Rennie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002830:Choroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D015353:Eye Enucleation; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000532:radiotherapy* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D061766:Proton Therapy / Q000379:methods*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D014604:Uveal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D014792:Visual Acuity; D000098943:Uveal Melanoma