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.

Download full-text


Available from: Bertil Damato, Jul 21, 2015
  • Source
    • "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, "
    [Show abstract] [Hide abstract]
    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.
    Preview · Article · Jul 2010 · Acta ophthalmologica
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To evaluate outcome of surgical resection of iris and irido-ciliary melanomas. Method: Retrospective analysis of all cases treated in Denmark 1975–1999 with clinical follow-up in 2002 and death certificate analysis in 2008. A quality of life questionnaire was completed at follow-up. Results: A total of 53 patients were identified. Of these, 47 were examined at follow-up. Median observation time was 7.15 years (range 0.3–27.4 years). Five patients had died of nonmelanoma causes, and one could not be reached because of immigration. None of the patient had melanoma metastases, and none had died of melanoma-related causes. Only one patient had a local recurrence, which was successfully treated by cryotherapy. The quality of life-related questions demonstrated that most patients (40) suffered from photophobia, and eight patients had changed their driving habits, not driving at night time. However, none had changed job as a consequence of the surgical treatment. Only two patients were emotionally affected by the diagnosis of iris melanoma. Conclusion: Resection of small iris and irido-ciliary melanomas is a safe and efficient procedure, provided that strict diagnostic and surgical procedures are followed and the preoperative intraocular pressure is normal.
    Full-text · Article · Apr 2010 · Acta ophthalmologica
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In view of the continued increase in the number of hadron (i.e. neutron, proton and light or heavy ion) therapy (HT) centres we performed a systematic literature review to identify reports of the efficacy of HT. Eleven databases were searched systematically. No limit was applied to language or study design. Established experts were contacted for unpublished data. Data on outcomes were extracted and summarised in tabular form. Seven hundred and seventy three papers were identified. For proton and heavy ion therapy, the number of RCTs was too small to draw firm conclusions. Based on prospective and retrospective studies, proton irradiation emerges as the treatment of choice for some ocular and skull base tumours. For prostate cancer, the results were comparable with those from the best photon therapy series. Heavy ion therapy is still in an experimental phase. Existing data do not suggest that the rapid expansion of HT as a major treatment modality would be appropriate. Further research into the clinical and cost-effectiveness of HT is needed. The formation of a European Hadron Therapy Register would offer a straightforward way of accelerating the rate at which we obtain high-quality evidence that could be used in assessing the role of HT in the management of cancer.
    Full-text · Article · Jun 2007 · Radiotherapy and Oncology
Show more