title: Predictive risk factors for radiation retinopathy and optic neuropathy after proton beam therapy for uveal melanoma.
abstract: OBJECTIVE
  This study was performed in order to evaluate the incidence of radiation retinopathy and optic neuropathy occurring after proton beam therapy for uveal melanoma.
  
  
  METHODS
  Included in this study were all patients who had been treated with primary proton beam therapy for uveal melanoma at the oncology service between May 1998 and June 2014 with a minimum follow-up of 12 months. Excluded were all patients who underwent re-irradiation, or vitrectomy due to exudative retinal detachment or for tumor-resection.
  
  
  RESULTS
  During this period, 1127 patients matched the inclusion criteria, of whom 768 (68.1 %) and 463 (41.0 %) developed radiation retinopathy and optic neuropathy after a median time of 18.9 months (2.0-99.84 months) and 19.8 months (0.2-170.4 months), respectively. Mean follow-up was 53.4 months (12-170.4 months). Included were 558 men (49.5 %) and 569 women (50.5 %). Mean age was 61 years (16-89 years). Visual acuity slightly decreased from initial levels of 0.3 logMAR-0.4 logMAR in patients without developing any radiation-induced complication but severely decreased to 1.0 logMAR or 1.5 logMAR in the case of developing radiation retinopathy only or optic neuropathy, respectively. Independent risk factors for radiation retinopathy were a centrally (<2.5 mm from sensitive structures) located tumor or a thick tumor located more than 2.5 mm from sensitive structures, while those for radiation optic neuropathy comprised a short distance and applied dose to the optic disk.
  
  
  CONCLUSIONS
  The risk for radiation retinopathy is higher in central uveal melanoma. Mid-/peripheral tumors are at high risk for radiation retinopathy and maculopathy if presenting with increased thickness.
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. ira.seibel@charite.de.
authors.forename: Ira
authors.initials: I
authors.lastname: Seibel
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.|Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Dino
authors.initials: D
authors.lastname: Cordini
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: Annette
authors.initials: A
authors.lastname: Hager
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Tillner
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: Aline I
authors.initials: AI
authors.lastname: Riechardt
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.|Berlin Protonen am Helmholtz-Zentrum Berlin für Materialien und Energie, Charité Universitätsmedizin Berlin, Lise-Meitner-Campus, Berlin, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Heufelder
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: Anja M
authors.initials: AM
authors.lastname: Davids
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
authors.forename: Matus
authors.initials: M
authors.lastname: Rehak
authors.affiliation: Augenklinik, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, 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; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D061766:Proton Therapy / Q000009:adverse effects*; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012164:Retinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014604:Uveal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy*; D014792:Visual Acuity; D055815:Young Adult; D000098943:Uveal Melanoma
keywords: Proton beam therapy; Radiation retinopathy; Tumor resection; Uveal melanoma