Outcomes of Proton Beam Radiotherapy for Large Non-Peripapillary Choroidal and Ciliary Body Melanoma at TRIUMF and the BC Cancer Agency

Abstract

Background and Purpose: To report outcomes and toxicity after proton beam radiotherapy for non-peripapillary choroidal and ciliary body melanoma considered unsuitable for other eye-sparing therapies. Materials and Methods: An existing database of 77 patients with non-peripapillary tumors treated at TRIUMF, Canada, including patient, tumor, and treatment characteristics, was updated with ocular complications and follow-up status from chart reviews. Results: Most of the patients had large tumors: 61% were T3/T4 tumors (AJCC classification), while 48% were large by the Collaborative Ocular Melanoma Study classification. The median thickness was 7.1 mm, and the ciliary body was involved in 35%. After 5 and 10 years, the actuarial ocular tumor control rate was 85 and 85%, metastasis-free survival was 72 and 57%, overall survival was 77 and 63%, the enucleation rate was 22 and 22%, and complete blindness was found in 38 and 38%, respectively. On univariate analysis, patients with ciliary body involvement had significantly worse metastasis-free survival and overall survival rates compared to patients without ciliary body involvement (p < 0.001). Conclusions: Proton therapy for large anteriorly located tumors resulted in acceptable ocular tumor control and survival rates. The risk of blindness and severe toxicity requiring enucleation was low, and a substantial proportion of patients maintained useful vision.

Characterization of the HollandPTC proton therapy beamline dedicated to uveal melanoma treatment and an interinstitutional comparison

“…Although technical differences leading to clinical discrepancies cannot be ignored as shown in this study, a high local tumor control of up to 95% is reported by all the institutions. [2][3][4][5][6][7][8][9][10] The distal fall-off is determined by the beam design properties and the initial energy leaving from the accelerator. The ideal scenario would be using a low-energy cyclotron dedicated to the treatment of ocular lesions resulting in the sharpest distal penumbra for all possible combinations of the RMWs and the range shifter values like in HZB-Charite, Berlin, and CAL, Nice.…”

Novel Gd3+-doped silica-based optical fiber material for dosimetry in proton therapy

“…Proton irradiations were performed at the Proton Therapy facility at TRIUMF 24 , the only Proton Therapy centre in Canada to date 25,26 , and one of several centers specializing in treating ocular cancer worldwide 27 . The facility consists of a dedicated horizontal beam line, extracting 74 MeV protons from the TRIUMF main cyclotron 28 .…”

Iatrogenic Ocular Surface Diseases Occurring during and/or after Different Treatments for Ocular Tumours

“…It results in local control of the disease in more than 95% of cases and in a relatively high rate of eye preservation [ 66 , 67 , 68 , 69 , 70 , 71 ]. Side effects of PBR depend mainly on the size and location of the tumour [ 72 , 73 , 74 , 75 , 76 , 77 , 78 ]. Radiation keratopathy represents a possible complication after PBR occurring in 1–11.5% of cases [ 66 , 68 , 78 , 79 ].…”

“…Other complications reported following PBP include pseudophakic bullous keratopathy (2%) and dry eye disease (6%) [ 84 , 87 , 88 , 89 ]. However, most studies reported no impairment of the ocular surface [ 67 , 75 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ]. Figure 3 shows the management of toxicity in a patient affected by large cilio-choroidal melanoma with diffuse iris invasion, treated with PBR to the entire anterior segment.…”