Proton radiation therapy for medium and large choroidal melanoma: Preservation of the eye and its functionality

Purpose: Evaluation of efficacy and safety of proton radiation therapy (PRT ) for medium- and large-size choroidal melanoma with focus on preservation of the eye and its function. Methods: Retrospective review of 78 patients with 60 medium and 18 large-si ze choroidal melanomas at a median follow-up of 34 months, Results: The 5-year data for local control, metastases-free survival, and d isease-specific survival were estimated to be 90.5 +/- 3.7%, 76.2 +/- 6.7%, and 75.6 +/- 7.6%, respectively. Eye preservation was achieved in 75.3% of patients, with useful (better than 20/200) visual acuity (VA) in 49.1% of surviving patients. Both total failure and complications led to enucleation , Prognosticators were tumor close to the optic disc (p = 0.003), large tum ors involving the ciliary body (p = 0.041), and local failure (p < 0.001), Prognostic factors for VA following PRT were initial VA (p = 0.001), doses to optic disc (p = 0.001) and fovea (p = 0.022) higher than 35 CGE (Cobalt Gray equivalent), tumor close to the optic disc (p = 0.034), and retinal de tachment (p < 0.001). Tumor basis diameter was significantly related to met astases free survival (p = 0.02), overall survival (p = 0.033), and disease specific survival (p = 0.017), but did not impair local tumor control, rat e of enucleation, and VA, Conclusion: The present data suggest that PRT is an effective and safe trea tment for medium and large size choroidal melanoma, PRT can preserve the ey e and its function in a reasonable percentage of patients. Further evaluati on in controlled clinical trials comparing PRT to plaque radiotherapy and e nucleation is required. (C) 2001 Elsevier Science Inc.