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Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy

SIMPLE SUMMARY: This study aims to assess cancer control and preservation of the eye and visual acuity after proton therapy abroad for eye melanoma. For this, medical files were reviewed of Dutch uveal melanoma patients who were treated in Switzerland with proton therapy from 1987 to 2019. The tumou...

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Autores principales: Marinkovic, Marina, Pors, Lennart J., van den Berg, Vincent, Peters, Femke P., Schalenbourg, Ann, Zografos, Leonidas, Pica, Alessia, Hrbacek, Jan, Van Duinen, Sjoerd G., Vu, T. H. Khanh, Bleeker, Jaco C., Rasch, Coen R. N., Jager, Martine J., Luyten, Gregorius P. M., Horeweg, Nanda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8699723/
https://www.ncbi.nlm.nih.gov/pubmed/34944862
http://dx.doi.org/10.3390/cancers13246241
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author Marinkovic, Marina
Pors, Lennart J.
van den Berg, Vincent
Peters, Femke P.
Schalenbourg, Ann
Zografos, Leonidas
Pica, Alessia
Hrbacek, Jan
Van Duinen, Sjoerd G.
Vu, T. H. Khanh
Bleeker, Jaco C.
Rasch, Coen R. N.
Jager, Martine J.
Luyten, Gregorius P. M.
Horeweg, Nanda
author_facet Marinkovic, Marina
Pors, Lennart J.
van den Berg, Vincent
Peters, Femke P.
Schalenbourg, Ann
Zografos, Leonidas
Pica, Alessia
Hrbacek, Jan
Van Duinen, Sjoerd G.
Vu, T. H. Khanh
Bleeker, Jaco C.
Rasch, Coen R. N.
Jager, Martine J.
Luyten, Gregorius P. M.
Horeweg, Nanda
author_sort Marinkovic, Marina
collection PubMed
description SIMPLE SUMMARY: This study aims to assess cancer control and preservation of the eye and visual acuity after proton therapy abroad for eye melanoma. For this, medical files were reviewed of Dutch uveal melanoma patients who were treated in Switzerland with proton therapy from 1987 to 2019. The tumours of these patients were too large and/or localised too close to the optic nerve to be treated with local plaque irradiation. There were 103 patients, of whom one had a uveal melanoma in both eyes. The tumours were relatively large and often localised around the central part of the retina. At five years after treatment, proton therapy had controlled the uveal melanomas of 94% of the patients and 81% had preserved their eye. Spread of the cancer beyond the eye was observed in 30% of the patients. Most patients (79%) became blind or had severe visual impairment after proton therapy; a small group of patients had mild or no visual impairment (17%). The size of the tumour, its localisation and the dose of proton therapy were important for the risk of decline in visual acuity. This study shows that proton therapy abroad for uveal melanoma is feasible and yields good results. ABSTRACT: Objective: To assess oncological and ophthalmological outcomes after international referral of uveal melanoma patients for proton therapy. Materials and Methods: This is a retrospective study among Dutch uveal melanoma patients who were treated in Switzerland with 60.0 CGE proton therapy (in 4 fractions) from 1987 to 2019. All patients were ineligible for brachytherapy due to tumour size and/or proximity to the optic nerve. Time-to-event analyses were performed using Kaplan–Meier’s methodology and Cox proportional hazards models. Results: There were 103 patients (104 eyes) with a median largest tumour diameter of 19 mm (range 6–26 mm). Tumours were localised centrally (11%), mid-peripherally (65%) or peripherally (34%). Median follow-up was 7 years. Five-year local control, distant metastasis-free survival and eye preservation rates were 94%, 70% and 81% respectively. At five years, severe, moderate and mild visual impairment was observed in respectively 79%, 4% and 6% of the patients. Larger tumour volumes and more central tumour localisation were associated with severe visual impairment. After correction for these factors, dose to the macula, optic disc and retina, but not optic nerve was significantly associated with severe visual impairment. Conclusion: International referral for proton therapy yielded good tumour control and eye preservation rates, but risk of distant metastasis and severe visual impairment were substantial, possibly due to the selection of advanced tumour stages and/or central localisation. Dose to the macula may be more relevant than dose to the optic nerve for preservation of visual acuity, which is relevant for the treatment planning of proton therapy.
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spelling pubmed-86997232021-12-24 Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy Marinkovic, Marina Pors, Lennart J. van den Berg, Vincent Peters, Femke P. Schalenbourg, Ann Zografos, Leonidas Pica, Alessia Hrbacek, Jan Van Duinen, Sjoerd G. Vu, T. H. Khanh Bleeker, Jaco C. Rasch, Coen R. N. Jager, Martine J. Luyten, Gregorius P. M. Horeweg, Nanda Cancers (Basel) Article SIMPLE SUMMARY: This study aims to assess cancer control and preservation of the eye and visual acuity after proton therapy abroad for eye melanoma. For this, medical files were reviewed of Dutch uveal melanoma patients who were treated in Switzerland with proton therapy from 1987 to 2019. The tumours of these patients were too large and/or localised too close to the optic nerve to be treated with local plaque irradiation. There were 103 patients, of whom one had a uveal melanoma in both eyes. The tumours were relatively large and often localised around the central part of the retina. At five years after treatment, proton therapy had controlled the uveal melanomas of 94% of the patients and 81% had preserved their eye. Spread of the cancer beyond the eye was observed in 30% of the patients. Most patients (79%) became blind or had severe visual impairment after proton therapy; a small group of patients had mild or no visual impairment (17%). The size of the tumour, its localisation and the dose of proton therapy were important for the risk of decline in visual acuity. This study shows that proton therapy abroad for uveal melanoma is feasible and yields good results. ABSTRACT: Objective: To assess oncological and ophthalmological outcomes after international referral of uveal melanoma patients for proton therapy. Materials and Methods: This is a retrospective study among Dutch uveal melanoma patients who were treated in Switzerland with 60.0 CGE proton therapy (in 4 fractions) from 1987 to 2019. All patients were ineligible for brachytherapy due to tumour size and/or proximity to the optic nerve. Time-to-event analyses were performed using Kaplan–Meier’s methodology and Cox proportional hazards models. Results: There were 103 patients (104 eyes) with a median largest tumour diameter of 19 mm (range 6–26 mm). Tumours were localised centrally (11%), mid-peripherally (65%) or peripherally (34%). Median follow-up was 7 years. Five-year local control, distant metastasis-free survival and eye preservation rates were 94%, 70% and 81% respectively. At five years, severe, moderate and mild visual impairment was observed in respectively 79%, 4% and 6% of the patients. Larger tumour volumes and more central tumour localisation were associated with severe visual impairment. After correction for these factors, dose to the macula, optic disc and retina, but not optic nerve was significantly associated with severe visual impairment. Conclusion: International referral for proton therapy yielded good tumour control and eye preservation rates, but risk of distant metastasis and severe visual impairment were substantial, possibly due to the selection of advanced tumour stages and/or central localisation. Dose to the macula may be more relevant than dose to the optic nerve for preservation of visual acuity, which is relevant for the treatment planning of proton therapy. MDPI 2021-12-13 /pmc/articles/PMC8699723/ /pubmed/34944862 http://dx.doi.org/10.3390/cancers13246241 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Marinkovic, Marina
Pors, Lennart J.
van den Berg, Vincent
Peters, Femke P.
Schalenbourg, Ann
Zografos, Leonidas
Pica, Alessia
Hrbacek, Jan
Van Duinen, Sjoerd G.
Vu, T. H. Khanh
Bleeker, Jaco C.
Rasch, Coen R. N.
Jager, Martine J.
Luyten, Gregorius P. M.
Horeweg, Nanda
Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy
title Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy
title_full Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy
title_fullStr Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy
title_full_unstemmed Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy
title_short Clinical Outcomes after International Referral of Uveal Melanoma Patients for Proton Therapy
title_sort clinical outcomes after international referral of uveal melanoma patients for proton therapy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8699723/
https://www.ncbi.nlm.nih.gov/pubmed/34944862
http://dx.doi.org/10.3390/cancers13246241
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