Conservation treatment of the eye: Conformal proton reirradiation for recurrent uveal melanoma
Department of Medicine, Division of Preventive and Behavioral Medicine
Adult; Aged; Aged, 80 and over; Confidence Intervals; Eye Enucleation; Female; Follow-Up Studies; Humans; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Protons; Radiotherapy, Conformal; Retrospective Studies; Treatment Outcome; Uveal Neoplasms
Eye Diseases | Neoplasms | Oncology | Radiology
PURPOSE: To evaluate the outcomes of a second course of proton beam radiation therapy (PBRT) in patients with recurrent uveal melanoma.
METHODS AND MATERIALS: Thirty-one patients received a second course of PBRT. The mean interval between the first and the second PBRT course was 50.2 months (range, 8-165 months). Most patients (87%) received 70 cobalt Gray equivalent (CGE) for both courses. Visual acuity was 20/200 or better in 30 patients initially and in 22 patients at the second treatment. The mean follow-up time after the second treatment was 50 months (range, 6-164 months).
RESULTS: At the time of the last follow-up, 20 patients were classified as having no evidence of disease, defined as tumor regression or an absence of tumor progression. Nine eyes (29%) were enucleated because of local recurrence (n = 5) or intractable pain (n = 4). The 5-year eye retention rate was 55% (95% confidence interval: 25.2-77.4). Six of the 22 patients who retained the eye (27%) had useful vision (20/200 or better).
CONCLUSIONS: A second course of PBRT for recurrent uveal melanoma to total doses between 118 and 140 CGE was associated with a relatively good probability of local control and a low enucleation rate. Although most patients lost vision, the majority were able to retain the reirradiated eye. Further evaluation is needed to assess metastasis-free survival of additional proton irradiation vs. enucleation after local recurrence.
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Citation: Marucci L, Lane AM, Li W, Egan KM, Gragoudas ES, Adams JA, Collier JM, Munzenrider JE. Conservation treatment of the eye: Conformal proton reirradiation for recurrent uveal melanoma. Int J Radiat Oncol Biol Phys. 2006 Mar 15;64(4):1018-22. Link to article on publisher's site