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Neoadjuvant proton beam irradiation vs. adjuvant ruthenium brachytherapy in transscleral resection of uveal melanoma

  • Oncology
  • Published:
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Abstract

Background

Uveal melanoma is the most common primary ocular malignancy in adults in the USA and Europe. The optimal treatment of large uveal melanoma is still under debate. Radiation therapy has its limitation due its eye-threatening secondary complications and is therefore often combined with surgical excision of the tumor.

Methods

In a retrospective interventional review, we evaluated in total 242 patients with uveal melanoma that underwent transscleral tumor resection with a predefined protocol, either with adjuvant ruthenium brachytherapy (Ru-106 group, n 136,), or with neoadjuvant proton beam therapy (PBT group, n 106). Kaplan-Meier estimates with log-rank test were used to show survival curves and a multivariable Cox regression model was used to calculate adjusted rate ratios.

Results

Local tumor recurrence rates after 3 and 5 years were 4% (95% CI 1.2–17.8%) and 9.1% (95% CI 2.9–27.3%), respectively, in the PBT group and 24.6% (95% CI 15.8–37.1%) and 27.5 (95% CI 17.8–41.1%), respectively, in the Ru-106 group. This leads to an overall recurrence rate almost 4 times higher in the Ru-106 group compared to the PBT group. After adjusting for the a priori confounders and the tumor distance to optic disc and ciliary body infiltration, the adjusted risk of tumor recurrence was 8 times (RR 7.69 (2.22–26.06), p < 0.001) higher in the Ru-106 group as compared to the PBT group. Three- and 5-year metastatic rates were 23.2% (95% CI 5.6–37.1%) and 31.8% (95% CI 20.7–46.8%), respectively, in the PBT group and 13.2% (95% CI 6.8–24.9%) and 30.3% (95% CI 18.3–47.5%), respectively, in the Ru-106 group. There was no statistically significant difference in the overall metastasis rate between the two groups even after adjusting for possible confounders.

Conclusion

Transscleral resection of large uveal melanomas combined with neoadjuvant proton beam therapy leads to a lower local tumor recurrence rate compared to transscleral tumor resection with adjuvant ruthenium brachytherapy. There was no statistically significant difference in the occurrence of rubeosis iridis, neovascular glaucoma, and in the need for enucleation later on.

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Author notes

  1. Alexander Böker and Daniel Pilger contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Campus Benjamin Franklin and Virchow Klinikum, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Germany

    Alexander Böker, Daniel Pilger, Dino Cordini, Ira Seibel, Aline I. Riechardt & Antonia M. Joussen

  2. Lise-Meitner-Campus, Berlinprotonen at the Helmholtz-Zentrum Berlin, Berlin, Germany

    Dino Cordini

  3. Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria

    Nikolaos E. Bechrakis

Authors
  1. Alexander Böker
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  2. Daniel Pilger
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  3. Dino Cordini
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  4. Ira Seibel
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  5. Aline I. Riechardt
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  6. Antonia M. Joussen
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  7. Nikolaos E. Bechrakis
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Correspondence to Alexander Böker.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Böker, A., Pilger, D., Cordini, D. et al. Neoadjuvant proton beam irradiation vs. adjuvant ruthenium brachytherapy in transscleral resection of uveal melanoma. Graefes Arch Clin Exp Ophthalmol 256, 1767–1775 (2018). https://doi.org/10.1007/s00417-018-4032-7

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  • DOI: https://doi.org/10.1007/s00417-018-4032-7

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