International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationDry Eye Syndrome After Proton Therapy of Ocular Melanomas
Introduction
High-dose brachytherapy and proton therapy (PT) are now standard treatment for uveal melanomas. Enucleation is now reserved for failure of conservative treatment or very large ocular melanomas 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. The choice of technique is guided by local staff expertise and equipment (11). Currently, one controversial issue is the use of PT for uveal melanomas in the superotemporal (ST) location owing to proximity of the lacrimal gland (LG) and risk of severe radiation-induced dry eye syndrome (DES). Some teams have contraindicated PT for such tumor locations, whereas others consider them a relevant indication for PT. Such data are increasingly relevant to cancer centers as PT facilities are expanding rapidly worldwide. The International Dry Eye Workshop defines DES as a disease affecting tears and ocular surface, resulting in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface 12, 13, 14, 15. Although mild to moderate DES is often successfully managed with supportive therapy, severe DES (sDES) may result in irreversible corneal damage with compromised vision, severe pain, and eye loss. Ocular morbidity after external beam radiation therapy is rarely reported but can severely affect patient quality of life 12, 13.
This study aimed to determine the DES rate and risk factors for DES and sDES in patients treated with PT. It also aimed to determine whether irradiation of melanomas in ST locations led to more frequent vision loss and enucleation, thus precluding PT.
Section snippets
Methods and Materials
All uveal melanoma patients underwent PT at our institution with a dose of 52 Gy (prescribed dose, not allowing for the relative biologic effectiveness correction of 1.1) during 4 days. The study was approved by our institutional review board. Patients underwent physical examination, ultrasound eye examination, and retinography/angiography before and after treatment, as per follow-up. Treatment planning and irradiation have been described elsewhere (14). Our uveal melanoma database has been
Results
From 2005 to 2015, 853 consecutive patients were recorded in the uveal melanoma database. Median follow-up time was 44 months, with an interquartile range of 18 to 60 months (range, 0.5-118 months). Patient, tumor, and treatment characteristics are presented in Table 1. Of the 853 patients, 30.5% (260) had a temporal tumor and 11.4% (97) an ST tumor. Mean (±SD) age was 64 ± 14 years. The sex ratio was approximately 1:1, with 48.2% (411) males. The prevalence of diabetes and high blood pressure
Discussion
This study is the largest study reporting on radiation-induced DES in uveal melanoma patients and irradiated patients in general. Some onco-ophthalmology centers contraindicate PT in ST uveal melanomas because of the risk of DES, despite the lack of published PT data in this population. In contrast, sDES has been found to be responsible for secondary enucleation after various forms of ionizing radiation and in up to 23% of patients treated with external beam radiation therapy for head and neck
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Single-Masked Randomized Phase 2 Study Assessing 2 Forms of Hypofractionated Proton Therapy in Patients With Large Choroidal Melanomas
2023, International Journal of Radiation Oncology Biology Physics30 years of ocular proton therapy, the Nice view
2022, Cancer/RadiotherapieCitation Excerpt :We have reported the various characteristics of a dedicated eye PT facility and showed the importance of appropriate nominal energy and beam line devices to achieve optimal quality for eye treatments in terms of dose planning and delivery accuracy. We have also demonstrated excellent outcomes in multiple clinical situations with the MEDICYC installation in terms of tumor control and toxicities [4–7,9,10,12,15,26,58–61]. Tumor control rates for uveal melanomas are in the order of 95% at five years and visual acuity may be preserved even for posterior pole tumors that are within 3 mm of the macula or optic disk [4].
Improving organs-at-risk sparing for choroidal melanoma patients: A CT-based two-beam strategy in ocular proton therapy with a dedicated eyeline
2022, Radiotherapy and OncologyCitation Excerpt :An increase in likelihood for radiation retinopathy has also been observed in the treatment of choroidal hemangioma even with low doses [42,43]. Finally, the two-beam strategy also improved the lacrimal gland D2% in GrB patients, which might lead to a reduced dry-eye syndrome incidence [44,45]. For posterior tumors (GrA and GrB), the sparing of the anterior segment with a two-beam arrangement comes at the cost of a small increased dose to the optic nerve (Fig. 4).
Dose-Response and Normal Tissue Complication Probabilities after Proton Therapy for Choroidal Melanoma
2021, OphthalmologyCitation Excerpt :For dry eye syndrome, the only variable associated with increased risk was the optic disc-to-tumor distance: the longer the distance, the higher the risk. This lack of dependence may be explained by the lack of the lachrymal gland contouring in the treatment planning system; consequently, it was not possible to explore all relevant dose relationships.26 We used advanced statistical methodology for selecting appropriate variables to include in the analyses.
The Lens Opacities Classification System III Grading in Irradiated Uveal Melanomas to Characterize Proton Therapy-Induced Cataracts
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Conflict of interest: none.