Intraocular inflammation after proton beam irradiation for uveal melanoma

Aim-To describe the inflammatory reaction that can occur following proton b eam irradiation of uveal melanomas based on a large series of patients and to try to determine the risk factors for this reaction. Methods-Data from a cohort of patients with uveal melanoma treated by proto n beam irradiation between 1991 and 1994 were analysed. The presence of inf lammation was recorded and evaluated. Kaplan-Meier estimates and statistica l analysis of general and tumour related risk factors were performed. Results-28% of patients treated during this period presented with ocular in flammation (median follow up 62 months). Risks factors were essentially tum our related and were correlated with larger lesions (height > 5 mm, diamete r > 12 mm, volume > 0.4 cm(3)). Multivariate analysis identified initial tu mour height and irradiation of a large volume of the eye as the two most im portant risk factors. Ocular inflammation usually consisted of mild anterio r uveitis, resolving rapidly after topical steroids and cycloplegics. The i ncidence of inflammation after proton beam irradiation of melanomas seems h igher than previously reported and is related to larger lesions. Evidence o f inflammation associated with uveal melanoma has been described and seems to be associated with tumour necrosis (spontaneous or after irradiation). T he appearance of transient inflammation during the follow up of these patie nts may be related to the release of inflammatory cytokines during tumour n ecrosis. Conclusion-Inflammation following proton beam irradiation is not unusual. I t is correlated with larger initial tumours and may be related to tumour ne crosis.