title: Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey.
abstract: OBJECTIVE
  To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs.
  
  
  METHODS
  Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow.
  
  
  RESULTS
  Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post-radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers.
  
  
  CONCLUSIONS
  The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades, increased use of MRI, development of clinical protocols, systematic patient-centered data acquisition, and publishing guidelines on QA, staffing, treatment, and follow-up parameters by dedicated ocular programs to ensure the highest level of care for ocular patients.
authors.affiliation: Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. Electronic address: Jan.hrbacek@psi.ch.
authors.forename: Jan
authors.initials: J
authors.lastname: Hrbacek
authors.affiliation: Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California.
authors.forename: Kavita K
authors.initials: KK
authors.lastname: Mishra
authors.affiliation: National Proton Therapy Centre, Clatterbridge Cancer Centre, Bebington, United Kingdom.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kacperek
authors.affiliation: Centre de Protonthérapie d'Orsay, Institut Curie, Orsay, France.
authors.forename: Remi
authors.initials: R
authors.lastname: Dendale
authors.affiliation: Centre de Protonthérapie d'Orsay, Institut Curie, Orsay, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Nauraye
authors.affiliation: Centre de Protonthérapie d'Orsay, Institut Curie, Orsay, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Auger
authors.affiliation: Centre Lacassagne, Nice, France.
authors.forename: Joel
authors.initials: J
authors.lastname: Herault
authors.affiliation: Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California.
authors.forename: Inder K
authors.initials: IK
authors.lastname: Daftari
authors.affiliation: F. H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Alexei V
authors.initials: AV
authors.lastname: Trofimov
authors.affiliation: F. H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Shih
authors.affiliation: F. H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Yen-Lin E
authors.initials: YE
authors.lastname: Chen
authors.affiliation: Protons for Therapy, Helmholtz-Zentrum Berlin, Berlin, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Denker
authors.affiliation: BerlinProtonen am HZB, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Heufelder
authors.affiliation: Institute of Nuclear Physic, Polish Academy of Sciences, Krakow, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Horwacik
authors.affiliation: Institute of Nuclear Physic, Polish Academy of Sciences, Krakow, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Swakoń
authors.affiliation: BC Cancer Agency - TRIUMF, Vancouver, Canada.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Hoehr
authors.affiliation: BC Cancer Agency - TRIUMF, Vancouver, Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Duzenli
authors.affiliation: Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
authors.forename: Alessia
authors.initials: A
authors.lastname: Pica
authors.affiliation: Centre de Protonthérapie d'Orsay, Institut Curie, Orsay, France.
authors.forename: Farid
authors.initials: F
authors.lastname: Goudjil
authors.affiliation: Centre de Protonthérapie d'Orsay, Institut Curie, Orsay, France.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mazal
authors.affiliation: Centre Lacassagne, Nice, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.affiliation: Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
authors.forename: Damien C
authors.initials: DC
authors.lastname: Weber
mesh_terms: D002170:Canada; D002173:Cancer Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D017357:Cyclotrons; D005134:Eye Neoplasms / Q000532:radiotherapy*; D005431:Florida; D005602:France; D005858:Germany; D006801:Humans; D008283:Maintenance; D008404:Massachusetts; D008545:Melanoma / Q000532:radiotherapy*; D010561:Personnel Staffing and Scheduling; D011044:Poland; D061766:Proton Therapy / Q000295:instrumentation / Q000592:standards / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D011879:Radiotherapy Dosage; D011881:Radiotherapy, Computer-Assisted / Q000379:methods; D012495:San Francisco; D011795:Surveys and Questionnaires; D013557:Switzerland; D006113:United Kingdom; D014604:Uveal Neoplasms / Q000532:radiotherapy*; D000098943:Uveal Melanoma