Abstract
PurposeTo evaluate why small- and certain medium-sized parapapillary choroidal melanoma (pcM) patients treated with hypo-fractionated proton therapy (PT) retain excellent long-term visual acuity (VA) and assess the negative predictive factors for retaining good vision (≤ 0.2 logMAR (≥ 0.6 decimal) after 5 years.MethodsThis single-center, retrospective, comparative study recruited consecutive pcM patients that were treated with PT. Between 1984 and 2005, 609 patients received a total of 60 CGE, of whom 310 met the following inclusion criteria: posterior tumor border ≤ 2.5 mm from the optic disc, largest tumor diameter ≤ 17.9 mm, tumor thickness ≤ 5.2 mm and available follow-up data for at least 5 years.ResultsMean follow-up was 120.8 ± 48.8 months (54.0–295.0). Out of 310 patients, 64 (21%) maintained a VA ≤ 0.2 logMAR (≥ 0.6 decimal) for at least 5 years following PT and were allocated to the “good visual outcome” (GVO) group, while the remaining 246 (79%) constituted the “poor visual outcome” (PVO) group, subdivided into 70 (22%) with a VA of 0.3–1.0 logMAR (0.1–0.5 decimal) and 157 (57%) patients with a VA > 1.0 logMAR (< 0.1 decimal). On multivariate analysis, older age (P = 0.04), tumor localization ≤ 0.5 mm to the fovea (P < 0.03), volume of the optic disc and macula receiving 50% of dose (30 CGE) (P = 0.02 and P < 0.001, respectively) were independent negative predictors of GVO.ConclusionsOf 310 small- to medium-sized pcM patients successfully treated with PT, 21% retained a VA ≤ 0.2 logMAR (≥ 0.6 decimal) for at least 5 years. Strongest negative predictive factor for retaining good long-term vision was the volume of the macula irradiated with at least 30 Gy.
Highlights
To evaluate why small- and certain medium-sized parapapillary choroidal melanoma patients treated with hypo-fractionated proton therapy (PT) retain excellent long-term visual acuity (VA) and assess the negative predictive factors for retaining good vision (B 0.2 logMAR (C 0.6 decimal) after 5 years
Secondary enucleation rates varied from 13.3 to 9.5% at 5 years and 17.1 to 10.7% at 10 years according to Lane [4] and Riechardt et al [5], respectively. They found that 20.3% [4] and 14% [5] of these challenging patients kept a useful vision of at least 1.0 logMAR (0.1 decimal) after five years in the treated eye following hypo-fractionated PT, despite a high-radiation dose delivered to the optic disc, and Thariat et al [6] reported that 31.9% had only a relative visual acuity (VA) loss of B 0.3 logMAR between 2 and 5 years following PT
Between 1984 and 2005, we identified 609 patients treated with PT for a Parapapillary choroidal melanoma (pcM), i.e., with a posterior tumor border located within a radius of 2.5 mm from the optic disc
Summary
To evaluate why small- and certain medium-sized parapapillary choroidal melanoma (pcM) patients treated with hypo-fractionated proton therapy (PT) retain excellent long-term visual acuity (VA) and assess the negative predictive factors for retaining good vision (B 0.2 logMAR (C 0.6 decimal) after 5 years. Secondary enucleation rates varied from 13.3 to 9.5% at 5 years and 17.1 to 10.7% at 10 years according to Lane [4] and Riechardt et al [5], respectively They found that 20.3% [4] and 14% [5] of these challenging patients kept a useful vision of at least 1.0 logMAR (0.1 decimal) after five years in the treated eye following hypo-fractionated PT, despite a high-radiation dose delivered to the optic disc, and Thariat et al [6] reported that 31.9% had only a relative visual acuity (VA) loss of B 0.3 logMAR between 2 and 5 years following PT. Why did certain eyes with pcM keep perfect vision up to 5 years following PT, while others with apparently similar tumors lost perception of light completely? What were the most important predictive factors for long-term vision? To answer these questions, we took a different approach and designed a comparative study, analyzing which parameters in patients with excellent long-term vision (B 0.2 logMAR (C 0.6 decimal) differed mostly from other patients
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