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Neoadjuvant proton beam irradiation followed by transscleral resection of uveal melanoma in 106 cases
  1. Gregor D Willerding1,2,
  2. Dino Cordini1,3,
  3. Lutz Moser4,5,
  4. Lothar Krause6,
  5. Michael H Foerster1,7,
  6. Nikolaos E Bechrakis8
  1. 1Department of Ophthalmology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
  2. 2Department of Ophthalmology, DRK Kliniken Westend, Berlin, Germany
  3. 3Berlinprotonen at the Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany
  4. 4Department of Radiotherapy and Radiation Oncology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
  5. 5Department of Radiotherapy, HELIOS Klinikum Emil von Behring, Berlin, Germany
  6. 6Department of Ophthalmology, Städtisches Klinikum, Dessau, Germany
  7. 7Augenärzte Kurfürstendamm 102, Berlin, Germany
  8. 8Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
  1. Correspondence to Professor Nikolaos E Bechrakis, Department of Ophthalmology, Medical University Innsbruck, Anichstr. 35, Innsbruck A-6020, Austria; nikolaos.bechrakis{at}i-med.ac.at

Abstract

Aims To describe results after neoadjuvant proton beam irradiation followed by transscleral resection of large uveal melanoma.

Methods Retrospective interventional case series, including 106 consecutive patients. Local tumour control, enucleation and metastasis development were assessed with survival curves. Predictors of local recurrence and metastasis were investigated with log-rank testing.

Results Mean follow-up was 3.2 years. Local recurrence occurred in five cases with an estimated risk of 4.2% and 10.4% at 3 and 5 years after treatment, respectively. Enucleation was performed in 10 cases with an estimated risk of 9.2% and 18.4% at 3 and 5 years, respectively. Significant risk factors for local recurrence were not evident. Metastasis was estimated to occur in 28.4% at 3 years and 40.3% at 5 years, correlating with patient's age only (p=0.01). Seventy four patients (69.8%) underwent vitreoretinal surgery for complications after tumour resection. Median visual acuity (VA) was 20/50 at diagnosis and 20/400 in the third year after treatment. VA preservation of 20/200 or better was achieved in 33 patients (31.1%).

Conclusion Neoadjuvant proton beam irradiation may help to prevent local recurrence after transscleral resection. Additional vitreoretinal surgery was frequently needed in the presented series. The majority of patients avoided enucleation and functional blindness.

  • Choroid
  • Ciliary body
  • Retina
  • Treatment Surgery

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