Proton beam radiotherapy of iris melanoma

Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, England, United Kingdom
International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.26). 09/2005; 63(1):109-15. DOI: 10.1016/j.ijrobp.2005.01.050
Source: PubMed


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.

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Available from: Bertil Damato, Jul 21, 2015
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    • "Treatment modalities for iris and iridociliary body melanomas are iridectomy, iridocyclectomy, proton beam irradiation, plaque radiation therapy and enucleation. (Arensten & Green 1975; Shields et al. 1995, 2003; Naumann & Rummelt 1996; Finger 2001; Damato et al. 2005; Fernandes et al. 2009). Plaque radiation therapy, "
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    ABSTRACT: To determine the long-term effects of ruthenium-106 plaque radiation therapy for iris and iridociliary melanomas in terms of tumour regression and complications. Between 1 November 1997 and 31 December 2007, 36 patients with an iris or iridociliary melanoma were treated with Ruthenium-106 (Ru-106) ophthalmic plaque radiation therapy. The median follow-up was 6.5 years with a range of 2-11 years. The mean tumour apex dose was 151.5 Gy. Main outcome measures were local tumour control and radiation-related ocular complications. The mean age of the patients at the time of treatment was 54 years (range 14-82). The tumours had a median largest basal dimension of 4.8 mm (range 3-11) and a prominence of 2.3 mm (range 0.8-5), with a median involvement of three clock hours (range 1-6). The tumours were confined to the iris in 14 patients (39%), extended into the anterior ciliary body in 12 (33%), while the anterior ciliary body tumour extended into the iris in ten patients (28%). Tumours regressed in all patients (100%) with a mean regression of 80% of the original tumour size at 7 years of follow-up. Radiation-related complications included corneal erosions on the first postoperative day in nine patients (25%), cataract in four of 11 patients free of cataract before treatment (36%) and postradiation glaucoma in one patient (3%). Visual acuity of 20/200 or worse was present in one of 20 patients (5%) at 6 years of follow-up. Local recurrences occurred in two patients (5%), 2 and 5 years after the radiation therapy respectively, and both underwent enucleation. Distant metastases occurred in one of these enucleated patients (3%) 2 years after treatment. Ru-106 plaque radiation therapy for iris and iridociliary melanoma resulted in good local tumour control and preservation of visual acuity with few and treatable side-effects.
    Acta ophthalmologica 07/2010; 90(3):291-6. DOI:10.1111/j.1755-3768.2010.01967.x · 2.84 Impact Factor
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    • "Melanoma of the iris constitutes approximately 10% of all uveal melanomas , and despite that some ocular cancer centres also apply radiotherapy in the treatment (Damato et al. 2005), the standard treatment for iris melanoma is iridectomy, and irido-cyclectomy for tumours also involving anterior parts of the ciliary body and angle (Conway et al. 2001). Outcomes of local excision surgery vary among reports (McGalliard & Johnston 1989; Naumann & Rummelt 1996; Conway et al. 2001; Shields et al. 2001) and depend on histological, therapeutic and surgical criteria. "
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    • "On proton therapy, two prospective phase I/II dose escalation studies (n = 594) [20] [42] and eight retrospective studies (seven case series and one comparison study ''proton vs. 125 I'', (n = 8928) [19] [21] [23] [26] [34] [37] [72] [103]) were identified . Weighted means for local tumour control and 5 year overall/cause specific survival were 97% and 85%/85%, respectively. "
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