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Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):328-35. doi: 10.1016/j.ijrobp.2015.12.011. Epub 2015 Dec 23.

Visual Outcomes of Parapapillary Uveal Melanomas Following Proton Beam Therapy.

Author information

1
Department of Radiation Therapy, Cancer Center Antoine Lacassagne-Nice Sophia Antipolis University Hospital, Nice, France. Electronic address: jthariat@gmail.com.
2
Department of Ophthalmology, Eye University Clinic la Croix Rousse, Lyon, France.
3
Department of Ophthalmology, National Institute for Cancer Research, Mura Delle Cappucine, Genova, Italy.
4
Eye Clinic, Centre d'Exploration et de Traitement de la Retine et de la Macula, Bordeaux, France.
5
Department of Ophthalmology, Eye University Clinic Pasteur 2, Nice, France.
6
Department of Ophthalmology, Eye University Clinic Gabriel Montpied, Clermont Ferrand, France.
7
Department of Ophthalmology, Eye University Clinic, Hopital Civil, Strasbourg, France.
8
Department of Radiation Therapy, NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany.
9
Department of Radiation Therapy, Cancer Center Antoine Lacassagne-Nice Sophia Antipolis University Hospital, Nice, France.

Abstract

PURPOSE:

In parapapillary melanoma patients, radiation-induced optic complications are frequent and visual acuity is often compromised. We investigated dose-effect relationships for the optic nerve with respect to visual acuity after proton therapy.

METHODS AND MATERIALS:

Of 5205 patients treated between 1991 and 2014, those treated using computed tomography (CT)-based planning to 52 Gy (prescribed dose, not accounting for relative biologic effectiveness correction of 1.1) in 4 fractions, with minimal 6-month follow-up and documented initial and last visual acuity, were included. Deterioration of ≥0.3 logMAR between initial and last visual acuity results was reported.

RESULTS:

A total of 865 consecutive patients were included. Median follow-up was 69 months, mean age was 61.7 years, tumor abutted the papilla in 35.1% of patients, and tumor-to-fovea distance was ≤3 mm in 74.2% of patients. Five-year relapse-free survival rate was 92.7%. Visual acuity was ≥20/200 in 72.6% of patients initially and 47.2% at last follow-up. A wedge filter was used in 47.8% of the patients, with a positive impact on vision and no impact on relapse. Glaucoma, radiation-induced optic neuropathy, maculopathy were reported in 17.9%, 47.5%, and 33.6% of patients, respectively. On multivariate analysis, age, diabetes, thickness, initial visual acuity and percentage of macula receiving 26 Gy were predictive of visual acuity. Furthermore, patients irradiated to ≥80% of their papilla had better visual acuity when limiting the 50% (30-Gy) and 20% (12-Gy) isodoses to ≤2 mm and 6 mm of optic nerve length, respectively.

CONCLUSIONS:

A personalized proton therapy plan with optic nerve and macular sparing can be used efficiently with good oncological and functional results in parapapillary melanoma patients.

PMID:
27084650
DOI:
10.1016/j.ijrobp.2015.12.011
[Indexed for MEDLINE]

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