title: Tumour Response in Uveal Melanomas Treated with Proton Beam Therapy.
abstract: OBJECTIVE
  Post-proton therapy surveillance of uveal melanomas relies on decreased thickness on repeat ultrasound B every 6 months for 2 years and yearly thereafter. Earlier pseudoprogression, a phenomenon described in other tumour types within the first months of irradiation, can also be observed in uveal melanomas and may lead to inappropriate enucleation. The Collaborative Ocular Melanoma Study (COMS) has defined ultrasound criteria to identify tumour progression after brachytherapy. We aimed to determine the reliability of ultrasound as a means to measure tumour height after proton therapy and predict local relapse.
  
  
  METHODS
  All 1992-2012 consecutive patients with at least three ultrasound B measurements during follow-up were included.
  
  
  RESULTS
  There were 55 local relapses of 886 patients (6.2%). Ultrasound B reliability was highest at 24 months, with specificity higher than 95% starting at 18 months.
  
  
  CONCLUSIONS
  Before 18 months post-proton therapy, the risk of falsely concluding in favour of a relapse exceeds 5% and should prompt repeat measurements 3 and 6 months later but should not prompt enucleation without further clinical assessment.
authors.affiliation: Department of Ophthalmology, Pasteur 2 Hospital, Nice Teaching Hospital, Nice, France. Electronic address: celia.maschi@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Maschi
authors.affiliation: Department of Radiation Oncology, Centre Lacassagne, Proton Therapy Center, Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Thariat
authors.affiliation: Department of Radiation Oncology, Centre Lacassagne, Proton Therapy Center, Nice, France.
authors.forename: J
authors.initials: J
authors.lastname: Herault
authors.affiliation: Department of Ophthalmology, Pasteur 2 Hospital, Nice Teaching Hospital, Nice, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Caujolle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology; D011379:Prognosis; D061766:Proton Therapy; D012074:Remission Induction; D015203:Reproducibility of Results; D015996:Survival Rate; D014463:Ultrasonography / Q000379:methods*; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D055815:Young Adult; D000098943:Uveal Melanoma
keywords: Enucleation; proton therapy; regression; tumour response; ultrasound; uveal melanoma