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Predictive factors for the development of rubeosis following proton beam radiotherapy for uveal melanoma
  1. Alexander J E Fossa,
  2. Irene Whelehana,
  3. John L Hungerforda,b,
  4. David F Andersonb,
  5. R Douglas Erringtonc,
  6. Andrzej Kacperekc,
  7. Marie Restorid,
  8. Jane Kongerudc,
  9. Martin Sheenc
  1. aOncology Clinic, Moorfields Eye Hospital, City Road, London EC1V 2PD, bOcular Oncology Service, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, cDouglas Cyclotron Unit, Wirral L63 4JY, dDepartment of Ultrasound, Moorfields Eye Hospital, City Road, London EC1V 2PD
  1. Mr John Hungerford, Moorfields Eye Hospital, City Road, London EC1V 2PD.


AIMS/BACKGROUND Proton beam radiotherapy can effectively treat primary uveal melanomas of any size. Some patients, however, develop adverse late effects following treatment and the purpose of this study was to determine which factors give rise to a poor local outcome.

METHODS The hospital records from a first cohort of 127 patients treated by protons from 1989 to 1992 were reviewed retrospectively. The presence of rubeosis was selected as a measure of significant ocular damage. Split file analysis was performed with 73 cases forming a test group with the remaining 54 cases acting as a validation group.

RESULTS Large tumour size and the presence of retinal detachment were significant, independent risk factors for developing rubeosis for both the test and validation groups. These factors also predicted subsequent enucleation for uncontrolled ocular pain. Patients with tumours too large to plaque and with an associated retinal detachment had a 90% chance of developing rubeosis within 4 years of proton beam radiotherapy.

CONCLUSIONS Patients with a uveal melanoma too large for plaque therapy and an associated retinal detachment run a very high risk of developing rubeosis after proton beam radiotherapy and one third of individuals developing rubeosis required enucleation for pain even if local tumour control was satisfactory.

  • proton beam radiotherapy
  • predictive factors
  • rubeosis
  • uveal melanoma

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