18 years experience of the use of proton beam in ophthalmic tumours

Abstract

Abstract Purpose Since 1991, more than 3000 patients were treated at Curie Institute by proton beam for uveal melanoma. All datas concerning tumor characteristics, treatment planning and follow up are registered in the data base Methods We have performed a retrospective review of patients treated before 2005. Patients were sent to Curie by their local ophtalmologist. Clip positioning and proton beam therapy with a dose of 60 grays in 4 fractions was scheduled; All patients were seen once a year in our clinic after treatment with liver ultrasounds twice a year. Results 2214 patients were treated, median age 61 years, median diameter 13,6 mm, median Thickness 4,7 mm. 20% of patients develloped metastasis,25% of patients died, 4% had local recurrences, 6,7% had secondary enucleations; With multivariate analysis Significant risk factors for metastasis were age (>60 ), tumor location, tumor diameter and tumor thickness( p<0,0001); Significant risk factor for local recurrence was tumor diameter (p<0,001) significant risk factor for secondary enucleation were tumor diameter (p<0,0001) and tumor thickness (p= 0,003) Neovascular glaucoma was 10% at 2years , 30% at 5 years and 34% at 10 years. Maculopathy was 40% at 2 years, 62% at 5 years and 66% at 10 years Optic neuropathy was 14% at 2 years, 29% at 5 years and 38% at 10 years At last follow up 36,2% of patients have more than 20/40 vision Conclusion Tumor control obtained by proton beam is excellent with a long follow up For big tumors news additional techniques like endoresections, additional TTT or antiVEGF could enhance globe preservation