Proton beam radiotherapy in the management of uveal melanoma: Clinical experience in Scotland
Samir Aziz1, Alex Taylor1, Andrzej McConnachie3, Alex Kacperek2, Ewan Kemp1
1Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK; 2Clatterbridge Centre for Oncology, Wirral, England, UK; 3Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
Aim: To evaluate proton-beam radiotherapy (PBRT) in the management of uveal melanoma in Scotland.
Methods: A retrospective review was undertaken on all patients receiving PBRT for uveal melanoma (1994–2005). Data obtained included: gender, past ocular/medical history, age, presenting complaint(s), diagnosis, laterality, tumor location/ultrasound characteristics, visual acuity (VA) and intraocular pressure. At post-treatment reviews (3, 6, 12, and 24 months), the following data was obtained: VA, intraocular pressure, tumor appearance and ultrasound characteristics. Mean follow up was 38.8 months.
Results: Seventy-six patients were included. Mean age was 64 years; male to female ratio was 1.1:1. Ninety-seven percent demonstrated initial treatment response; 87% had successful control of tumor growth. Mean pre-treatment tumor height was 6.2 mm v.s. 4.8 mm post-irradiation (p < 0.001). Pre-irradiation VA was <3/60 in 18.5% compared with 74% post-irradiation (p < 0.0001). There was a statistically significant association between adverse events (enucleation, metastasis) and greater maximal basal tumor diameter. Eighteen eyes were enucleated. The median survival time was estimated to be 54 months.
Conclusion: In our experience, PBRT is a precise, reliable and effective treatment in the management of large, and previously treated uveal melanomas. It prevents enucleation in the majority at short term follow-up.
Keywords: proton-beam radiotherapy, uveal melanoma, visual acuity, enucleation, tumor
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