Original article
Proton Beam Therapy Leads to Excellent Local Control Rates in Choroidal Melanoma in the Intermediate Fundus Zone

https://doi.org/10.1016/j.ajo.2014.08.016Get rights and content

Purpose

To evaluate long-term outcomes of proton beam radiotherapy in the treatment of choroidal melanoma of the intermediate zone of the fundus.

Design

Retrospective interventional single-center study.

Methods

The study was a retrospective analysis with long-term follow-up of 62 patients with a minimum tumor-to-disc and tumor-to-fovea distance of 2 mm of choroidal melanoma in the intermediate zone of the fundus. Mean values of tumor prominence, largest basal diameter, and tumor distances to the optic disc and fovea were 7.6, 12.8, 5.2, and 4.6 mm, respectively. All patients were irradiated with a total proton dose of 60 cobalt gray equivalents.

Results

After proton beam radiotherapy, 71.0% of the patients received subsequent endoresection of the tumor. Only 18 patients (29.0%) did not require additional tumor resection and were analyzed as a separate group. For the total of patients, the median follow-up time was 70.3 months. The 5-year Kaplan-Meier rates of local tumor relapse, enucleation, and distant metastasis were 3.9%, 3.7%, and 13.4%, respectively. Cataract surgery was the most frequent secondary treatment in our cohort.

Conclusions

In this study we demonstrate the effectiveness of proton beam irradiation in tumor control and preservation of the globe in the analyzed patients. The rate of metastasis was not higher than previously described. Nevertheless, consecutive tumor surgery is frequently required to maintain the eye in patients with large-sized choroidal melanomas. In conclusion, proton beam radiotherapy allows preservation of the eye in mid-zone choroidal melanomas.

Section snippets

Patients and Data Collection

This is a retrospective single-center study of patients with choroidal malignant melanoma treated with proton beam radiotherapy in Berlin. The study was approved by the institutional review board of the Charité–Universitätsmedizin Berlin, Germany, and was in accordance with the Declaration of Helsinki specifications. This study focuses on tumors in the intermediate zone of the fundus not attaching the ciliary body. The minimal distance of the unifocal lesion to both the optic disc and fovea was

Results

Sixty-two patients met the inclusion criteria of our retrospective study. The mean age was 57.7 years (standard deviation [SD] 13.6 years). Twenty-nine patients were female, 33 were male. The overall range for tumor prominence was 1.7–12.6 mm (mean 7.6 mm, SD 2.9 mm), and it was 6.6–21.5 mm (mean 12.8 mm, SD 3.4 mm) for the largest tumor diameter. The respective fovea and disc distances ranged from 2.0 both to 10.1 mm and 11.3 mm with a mean distance of 4.6 mm to the fovea (SD 2.2 mm) and

Discussion

The management of patients with medium- and large-size uveal melanoma in the intermediate zone of the fundus is challenging. Proton beam brachytherapy for large tumors has been reported with or without additional surgical resection of the tumor tissue. However, a long-term follow-up of these patients was lacking so far. The intention of this study was to present the outcomes of all patients with choroidal melanomas in the intermediate fundus zone who met the inclusion criteria irrespective of

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