Proton beam radiotherapy of iris melanoma.

St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK.
International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.18). 09/2005; 63(1):109-15. DOI: 10.1016/j.ijrobp.2005.01.050
Source: PubMed

ABSTRACT To report on outcomes after proton beam radiotherapy of iris melanoma.
Between 1993 and 2004, 88 patients with iris melanoma received proton beam radiotherapy, with 53.1 Gy in 4 fractions.
The patients had a mean age of 52 years and a median follow-up of 2.7 years. The tumors had a median diameter of 4.3 mm, involving more than 2 clock hours of iris in 32% of patients and more than 2 hours of angle in 27%. The ciliary body was involved in 20%. Cataract was present in 13 patients before treatment and subsequently developed in another 18. Cataract had a 4-year rate of 63% and by Cox analysis was related to age (p = 0.05), initial visual loss (p < 0.0001), iris involvement (p < 0.0001), and tumor thickness (p < 0.0001). Glaucoma was present before treatment in 13 patients and developed after treatment in another 3. Three eyes were enucleated, all because of recurrence, which had an actuarial 4-year rate of 3.3% (95% CI 0-8.0%).
Proton beam radiotherapy of iris melanoma is well tolerated, the main problems being radiation-cataract, which was treatable, and preexisting glaucoma, which in several patients was difficult to control.

1 Bookmark
  • [Show abstract] [Hide abstract]
    ABSTRACT: PurposeSurgical excision of peripheral iris or ciliary body melanomas can be performed antero-posteriorly (irido-cyclectomy) with mydriasis or postero-anteriorly (cyclo-iridectomy) with miosis. The aim of this study was to evaluate the results of both surgical techniques.Methods Patients were enrolled in the study if they underwent irido-cyclectomy or cyclo-iridectomy for iris and/or ciliary body melanoma at the Liverpool Ocular Oncology Centre between 1993 and 2012.ResultsThe 24 patients (8 male, 16 female) had a median age of 57 years. The largest median basal tumour diameter and the median tumour thickness were 4.8 and 2.2 mm, respectively. The resection was performed antero-posteriorly in 9 (37%) patients and postero-anteriorly or circumferentially in 15 (63%). Nine tumours contained epithelioid cells. Genetic studies were performed in 10 patients, showing chromosome 3 loss in two. Postoperative complications included hypotony in 9 (37%) patients, cataract in 8 (33%), hyphaema in 8 (33%), cyclodialysis in 1 (4%), wound dehiscence in 1 (4%) and bullous keratopathy in 1 patient (4%). The median follow-up time was 2.4 years. The last known visual acuity was 6/6-6/12 in 20 (91%) patients and 6/18-6/60 in 2 (9%), with 2 (8%) requiring secondary enucleation. Local tumour recurrence developed in 1 patient (4%). Two (8%) patients died of metastatic disease.Conclusions Surgical resection of peripheral iris melanomas achieves high rates of visual conservation and local tumour control and may be the preferred option when tissue is required for laboratory studies.Eye advance online publication, 11 April 2014; doi:10.1038/eye.2014.74.
    Eye (London, England) 04/2014; · 1.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report the clinical features and outcomes of iris melanomas treated by proton beam therapy.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Choroidal melanoma is the most common primary intraocular malignancy in adults. Alternative treatment modalities have been proposed in recent years including enucleation, local resection, plaque brachytherapy, charged-particle radiotherapy, stereotactic photon beam irradiation therapy, transpupillary thermotherapy and photodynamic therapy. This review aims to focus on all the available therapeutic options in choroidal melanoma and update the reader on the current status of each modality. Treatment of choroidal melanomas should be directed towards reducing the risk of recurrences, as it is known that recurrent tumors are associated with an increased rate of metastatic disease and poor prognosis. Advances in genetics and cytogenetics can enhance the accuracy of patient prognostication.
    Expert Review of Ophthalmology 01/2014; 7(2).


1 Download
Available from