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Graefes Arch Clin Exp Ophthalmol. 2019 Mar 27. doi: 10.1007/s00417-019-04286-2. [Epub ahead of print]

Proton radiotherapy in advanced malignant melanoma of the conjunctiva.

Author information

1
Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany. Simone.Scholz@uk-essen.de.
2
Centre Antoine-Lacassagne, 33 Avenue de Valombrose, 06100, Nice, France.
3
Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
4
Department of Epidemiology, School of Public Health, Boston University, Boston, USA.
5
Department of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
6
Dermapathologie bei Mainz, Nieder-Olm, Bahnhofstrasse 2B, 55268, Nieder-Olm, Germany.
7
Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
8
Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.
9
Department of Radiation Therapy, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.

Abstract

BACKGROUND:

The management of conjunctival melanoma is challenging and frequently ends in exenteration. The aim of this retrospective study was to evaluate the long-term results of proton beam radiation with regard to various clinical parameters.

METHODS:

Eighty-nine patients with extended conjunctival melanoma (≥T2) and multifocal bulbar located tumors (T1c/d) were treated consecutively with proton radiotherapy (dose 45 Gy). The following parameters were assessed: TNM stage, tumor origin, local recurrence, performance of exenteration, occurrence of metastases, overall survival, and potential complications. A time-to-event analysis was preformed to the primary endpoints: relapse, metastasis, exenteration, and death by use of Kaplan-Meier cumulative survival estimates and Cox proportional hazards regression that provides hazard ratios and 95% confidence intervals.

RESULTS:

The median follow-up time was 4.2 years (max. 21.7 years). Local recurrence and metastatic disease occurred in 33% and 16% of patients, respectively. Exenteration-free survival and overall survival tended to be worse in T3 melanoma. No association between tumor origin and local recurrence, metastatic disease, or overall survival was observed. Main complications after proton radiotherapy were sicca-syndrome (30%), secondary glaucoma (11%), and limbal stem cell deficiency (8%).

CONCLUSIONS:

In summary, proton radiotherapy in conjunctival melanoma is an effective alternative to exenteration, with a 5-year cumulative probability of eye preservation of 69%.

KEYWORDS:

Conjunctiva; Exenteration; Malignant melanoma; Metastasis; Proton radiotherapy; Recurrence

PMID:
30919076
DOI:
10.1007/s00417-019-04286-2

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