title: Visual Outcomes of Parapapillary Uveal Melanomas Following Proton Beam Therapy.
abstract: OBJECTIVE
  In parapapillary melanoma patients, radiation-induced optic complications are frequent and visual acuity is often compromised. We investigated dose-effect relationships for the optic nerve with respect to visual acuity after proton therapy.
  
  
  METHODS
  Of 5205 patients treated between 1991 and 2014, those treated using computed tomography (CT)-based planning to 52 Gy (prescribed dose, not accounting for relative biologic effectiveness correction of 1.1) in 4 fractions, with minimal 6-month follow-up and documented initial and last visual acuity, were included. Deterioration of ≥0.3 logMAR between initial and last visual acuity results was reported.
  
  
  RESULTS
  A total of 865 consecutive patients were included. Median follow-up was 69 months, mean age was 61.7 years, tumor abutted the papilla in 35.1% of patients, and tumor-to-fovea distance was ≤3 mm in 74.2% of patients. Five-year relapse-free survival rate was 92.7%. Visual acuity was ≥20/200 in 72.6% of patients initially and 47.2% at last follow-up. A wedge filter was used in 47.8% of the patients, with a positive impact on vision and no impact on relapse. Glaucoma, radiation-induced optic neuropathy, maculopathy were reported in 17.9%, 47.5%, and 33.6% of patients, respectively. On multivariate analysis, age, diabetes, thickness, initial visual acuity and percentage of macula receiving 26 Gy were predictive of visual acuity. Furthermore, patients irradiated to ≥80% of their papilla had better visual acuity when limiting the 50% (30-Gy) and 20% (12-Gy) isodoses to ≤2 mm and 6 mm of optic nerve length, respectively.
  
  
  CONCLUSIONS
  A personalized proton therapy plan with optic nerve and macular sparing can be used efficiently with good oncological and functional results in parapapillary melanoma patients.
authors.affiliation: Department of Radiation Therapy, Cancer Center Antoine Lacassagne-Nice Sophia Antipolis University Hospital, Nice, France. Electronic address: jthariat@gmail.com.
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.affiliation: Department of Ophthalmology, Eye University Clinic la Croix Rousse, Lyon, France.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Grange
authors.affiliation: Department of Ophthalmology, National Institute for Cancer Research, Mura Delle Cappucine, Genova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mosci
authors.affiliation: Eye Clinic, Centre d'Exploration et de Traitement de la Retine et de la Macula, Bordeaux, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Rosier
authors.affiliation: Department of Ophthalmology, Eye University Clinic Pasteur 2, Nice, France.
authors.forename: Celia
authors.initials: C
authors.lastname: Maschi
authors.affiliation: Department of Ophthalmology, National Institute for Cancer Research, Mura Delle Cappucine, Genova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanza
authors.affiliation: Department of Ophthalmology, Eye University Clinic la Croix Rousse, Lyon, France.
authors.forename: Anh Minh
authors.initials: AM
authors.lastname: Nguyen
authors.affiliation: Department of Ophthalmology, Eye University Clinic Gabriel Montpied, Clermont Ferrand, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Jaspart
authors.affiliation: Department of Ophthalmology, Eye University Clinic Gabriel Montpied, Clermont Ferrand, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bacin
authors.affiliation: Department of Ophthalmology, Eye University Clinic Gabriel Montpied, Clermont Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonnin
authors.affiliation: Department of Ophthalmology, Eye University Clinic, Hopital Civil, Strasbourg, France.
authors.forename: David
authors.initials: D
authors.lastname: Gaucher
authors.affiliation: Department of Radiation Therapy, NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sauerwein
authors.affiliation: Department of Radiation Therapy, Cancer Center Antoine Lacassagne-Nice Sophia Antipolis University Hospital, Nice, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Angellier
authors.affiliation: Department of Radiation Therapy, Cancer Center Antoine Lacassagne-Nice Sophia Antipolis University Hospital, Nice, France.
authors.forename: Joel
authors.initials: J
authors.lastname: Hérault
authors.affiliation: Department of Ophthalmology, Eye University Clinic Pasteur 2, Nice, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Caujolle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018572:Disease-Free Survival; D006801:Humans; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009898:Optic Disk / Q000528:radiation effects*; D009900:Optic Nerve / Q000528:radiation effects; D061766:Proton Therapy / Q000295:instrumentation / Q000379:methods; D011832:Radiation Injuries / Q000150:complications / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012062:Relative Biological Effectiveness; D015996:Survival Rate; D014604:Uveal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D014792:Visual Acuity / Q000528:radiation effects*; D000098943:Uveal Melanoma