Conservation treatment of the eye: Conformal proton reirradiation for recurrent uveal melanoma.


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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@article{Marucci2006ConservationTO, title={Conservation treatment of the eye: Conformal proton reirradiation for recurrent uveal melanoma.}, author={Laura Marucci and Anne Marie Lane and Wenjun Li and Kathleen M. Egan and Evangelos S. Gragoudas and Judy A. Adams and John Michael Collier and John E. Munzenrider}, journal={International journal of radiation oncology, biology, physics}, year={2006}, volume={64 4}, pages={1018-22} }