Original article
Local Recurrence After Primary Proton Beam Therapy in Uveal Melanoma: Risk Factors, Retreatment Approaches, and Outcome

https://doi.org/10.1016/j.ajo.2015.06.017Get rights and content

Purpose

To evaluate the risk factors, recurrence rates, retreatments, and long-term patient outcomes following proton beam therapy for uveal melanoma.

Design

Retrospective interventional case series.

Methods

All patients treated with primary proton beam therapy for uveal melanoma at the oncology service at Charité-Berlin and Helmholtz-Zentrum-Berlin between May 1998 and December 2008 were reviewed for local recurrence. Of 982 patients, 982 eyes matched the inclusion criteria. The data were obtained from electronic health records, operative reports, discharge letters, and radiation planning. Comparisons of fundus photographs and ultrasound measurements were performed to assess the growth pattern of the tumor and to determine the success of retreatment, in the case that a globe-retaining therapy was undertaken.

Results

Of 982 patients, 35 patients (3.6%) developed local recurrence. The median follow-up was 60.7 months (6.0–170.4 months). Local control rate was 96.4% and the overall eye retention rate was 95.0% in this cohort. Local recurrence was correlated with a higher risk for metastasis and reduced survival. Largest tumor diameter was identified as the sole statistically significant risk factor for local recurrence (P = .00001). All globe-retaining retreatment approaches for local recurrence, including proton beam therapy, brachytherapy, and transpupillary thermotherapy used for recurrences at the tumor margins, showed good local tumor control and similar metastasis-free survivals.

Conclusions

This study showed that each globe-retaining retreatment approach can result in satisfying local tumor control. In case of early detection of local recurrence, preservation of the globe can be warranted. Therefore, regularly performed follow-ups should be ensured.

Section snippets

Methods

The study was approved by the institutional review board of the Charité-Universitätsmedizin Berlin, Berlin, Germany, and was in accordance with the tenets of the Declaration of Helsinki. All patients with initial diagnosis of choroidal or ciliary body melanoma that were treated with primary proton beam therapy at the Ocular Oncology Service at Charité Berlin and the Helmholtz Center Berlin between May 1998 and December 2008 were reviewed for local recurrence. In the framework of our treatment

Results

We included 982 patients, of whom 35 patients (3.6%) developed local recurrence after proton beam therapy. The median follow-up was 60.7 months (6.0–170.4 months). The local tumor control rate was 96.4%. The Kaplan-Meier estimate for local recurrence was 2% (± 1%) at 1 year, 3% (± 1%) at 3 years, 4% (± 1%) at 5 years, and 6% (± 1%) at 10 years. After proton beam therapy, the median time local recurrence occurred was 17.5 months (1.3–88.7 months).

Time of overall survival differed significantly (P

Discussion

Proton beam therapy is a safe treatment option for uveal melanoma, resulting in good local control and eye retention rates. Our local control rate of 96% and 94% at 5 and 10 years, respectively, was very similar to the rate described by Egger and associates (96% and 95%).4 Our local recurrence rate of 4% at 5 years is also similar to rates previously described (2%–8.4% at 5 years).1, 3, 4, 5, 6, 7, 8, 9, 10, 11 The last recurrence in our study was detected 7.5 years after proton beam therapy,

References (23)

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