Abstract：
This study evaluated the functional outcome and ocular side effects of patients receiving proton beam radiotherapy (PBR) for the treatment of iris melanoma (IM).
This retrospective study analyzed prospectively collected data.
Patients with IM who underwent PBR as a primary treatment.
Treatment was given in the form of whole PBR (wPBR: n = 51) or segmental PBR (sPBR: n = 98).
Visual acuity (VA) and side effects were divided into ocular surface disease (OSD), secondary glaucoma, or cataract development.
A total of 149 eyes of 149 patients with a mean age of 53.9 ± 16.0 years were included. Tumor recurrence developed in 3 patients (wPBR: 1/51; sPBR: 2/98). Ocular surface disease was observed in 78.4% of the wPBR group (40/51) and 25.5% of the sPBR group (25/98) (P < 0.001) after 0.7 ± 1.2 years and 1.1 ± 0.9 years, respectively. The main side effect was dry eye syndrome in both groups, but severe side effects such as limbal stem cell failure were found only in the wPBR group (4/51; 7.8%). Secondary glaucoma developed in 31.4% of the wPBR group (16/51) compared with 1.0% in the sPBR group (1/98; P < 0.001). Glaucoma control was generally achieved with eye drops, whereas surgery was necessary in 5 patients (wPBR: 4/51, 7.8%; sPBR: 1/98, 1%). Cataract surgery was performed in 47.9% of the wPBR group (23/48) and 19.8% of the sPBR group (19/96) (P < 0.001). Before treatment, VA was 0.14 ± 0.27 logarithm of the minimum angle of resolution (logMAR) in the wPBR group and 0.04 ± 0.19 logMAR in the sPBR group. A worsening was seen in the wPBR group (0.55 ± 0.16 logMAR; P < 0.001) 6 months after radiotherapy, which normalized after 12 months (0.15 ± 0.30 logMAR; P = 0.17). In the sPBR group, no such decrease in VA was observed (6 months: 0.03 ± 0.22 logMAR, P = 0.54; 12 months: 0.04 ± 0.21 logMAR, P = 0.98).
Our results demonstrate that PBR is a very successful treatment option for patients with IM, showing a high tumor control rate and relatively low complication profile. Tumor recurrence was a rare event, and secondary enucleation was not necessary in any patient. Side effects are commonly seen, but severe side effects such as limbal stem cell failure or secondary glaucoma mainly developed after wPBR. These results are important for clinical decision making and discussion with the patient regarding this form of radiotherapy.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
This retrospective study analyzed prospectively collected data.
Patients with IM who underwent PBR as a primary treatment.
Treatment was given in the form of whole PBR (wPBR: n = 51) or segmental PBR (sPBR: n = 98).
Visual acuity (VA) and side effects were divided into ocular surface disease (OSD), secondary glaucoma, or cataract development.
A total of 149 eyes of 149 patients with a mean age of 53.9 ± 16.0 years were included. Tumor recurrence developed in 3 patients (wPBR: 1/51; sPBR: 2/98). Ocular surface disease was observed in 78.4% of the wPBR group (40/51) and 25.5% of the sPBR group (25/98) (P < 0.001) after 0.7 ± 1.2 years and 1.1 ± 0.9 years, respectively. The main side effect was dry eye syndrome in both groups, but severe side effects such as limbal stem cell failure were found only in the wPBR group (4/51; 7.8%). Secondary glaucoma developed in 31.4% of the wPBR group (16/51) compared with 1.0% in the sPBR group (1/98; P < 0.001). Glaucoma control was generally achieved with eye drops, whereas surgery was necessary in 5 patients (wPBR: 4/51, 7.8%; sPBR: 1/98, 1%). Cataract surgery was performed in 47.9% of the wPBR group (23/48) and 19.8% of the sPBR group (19/96) (P < 0.001). Before treatment, VA was 0.14 ± 0.27 logarithm of the minimum angle of resolution (logMAR) in the wPBR group and 0.04 ± 0.19 logMAR in the sPBR group. A worsening was seen in the wPBR group (0.55 ± 0.16 logMAR; P < 0.001) 6 months after radiotherapy, which normalized after 12 months (0.15 ± 0.30 logMAR; P = 0.17). In the sPBR group, no such decrease in VA was observed (6 months: 0.03 ± 0.22 logMAR, P = 0.54; 12 months: 0.04 ± 0.21 logMAR, P = 0.98).
Our results demonstrate that PBR is a very successful treatment option for patients with IM, showing a high tumor control rate and relatively low complication profile. Tumor recurrence was a rare event, and secondary enucleation was not necessary in any patient. Side effects are commonly seen, but severe side effects such as limbal stem cell failure or secondary glaucoma mainly developed after wPBR. These results are important for clinical decision making and discussion with the patient regarding this form of radiotherapy.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
摘要：
目的：这项回顾性研究评估了接受质子束放疗（PBR）治疗虹膜黑色素瘤（IM）的患者的功能结局和眼部副作用。
方法：回顾性研究分析了前瞻性收集的数据。参与者：接受PBR作为主要治疗的IM患者方法：以整个眼前节（wPBR：n=51）或节段质子束放疗（sPBR：n=98）的形式给予治疗。
方法：视力（VA）和眼部副作用分为眼表疾病（OSD），继发性青光眼或白内障的发展结果：共149例患者，平均年龄53.9±16.0岁。3例患者出现肿瘤复发(wPBR:1/51;sPBR:2/98)。在0.7±1.2年和1.1±0.9年后，wPBR组的78.4％（40/51）和sPBR组的25.5％（25/98）（p<0.001）观察到OSD，分别。两组的主要副作用是干眼综合征，但严重的副作用如角膜缘干细胞衰竭仅在wPBR组中发现（4/51；7.8％）。继发性青光眼发生在31.4%的wPBR(16/51)中,而sPBR组为1.0%(1/98;p<0.001)。青光眼控制通常是通过局部滴眼液实现的，5例患者需要手术治疗(wPBR:4/51,7.8%;sPBR:1/98,1%)。47.9%的wPBR(23/48)和19.8%的sPBR(19/96)组进行白内障手术(p<0.001)。治疗前,wPBR组的VA为0.14±0.27logMar，sPBR组为0.04±0.19logMar。放疗后6个月，wPBR恶化（0.55±0.16logMar；p<0.001），12个月后恢复正常（0.15±0.30logMar；p=0.17）。在sPBR组中，未观察到VA的这种下降（6mo：0.03±0.22logMar，p=0.54;12mo:0.04±0.21logMar,p=0.98）。
结论：我们的结果表明，对于IM患者，PBR是一种非常成功的治疗选择，显示出较高的肿瘤控制率和相对较低的并发症。肿瘤复发是罕见事件，任何患者都不需要二次摘除。副作用是常见的，但严重的副作用，如角膜缘干细胞衰竭或继发性青光眼主要发生在整个眼前节PBR之后。这些结果对于临床决策和与患者讨论这种形式的放射治疗非常重要。
方法：回顾性研究分析了前瞻性收集的数据。参与者：接受PBR作为主要治疗的IM患者方法：以整个眼前节（wPBR：n=51）或节段质子束放疗（sPBR：n=98）的形式给予治疗。
方法：视力（VA）和眼部副作用分为眼表疾病（OSD），继发性青光眼或白内障的发展结果：共149例患者，平均年龄53.9±16.0岁。3例患者出现肿瘤复发(wPBR:1/51;sPBR:2/98)。在0.7±1.2年和1.1±0.9年后，wPBR组的78.4％（40/51）和sPBR组的25.5％（25/98）（p<0.001）观察到OSD，分别。两组的主要副作用是干眼综合征，但严重的副作用如角膜缘干细胞衰竭仅在wPBR组中发现（4/51；7.8％）。继发性青光眼发生在31.4%的wPBR(16/51)中,而sPBR组为1.0%(1/98;p<0.001)。青光眼控制通常是通过局部滴眼液实现的，5例患者需要手术治疗(wPBR:4/51,7.8%;sPBR:1/98,1%)。47.9%的wPBR(23/48)和19.8%的sPBR(19/96)组进行白内障手术(p<0.001)。治疗前,wPBR组的VA为0.14±0.27logMar，sPBR组为0.04±0.19logMar。放疗后6个月，wPBR恶化（0.55±0.16logMar；p<0.001），12个月后恢复正常（0.15±0.30logMar；p=0.17）。在sPBR组中，未观察到VA的这种下降（6mo：0.03±0.22logMar，p=0.54;12mo:0.04±0.21logMar,p=0.98）。
结论：我们的结果表明，对于IM患者，PBR是一种非常成功的治疗选择，显示出较高的肿瘤控制率和相对较低的并发症。肿瘤复发是罕见事件，任何患者都不需要二次摘除。副作用是常见的，但严重的副作用，如角膜缘干细胞衰竭或继发性青光眼主要发生在整个眼前节PBR之后。这些结果对于临床决策和与患者讨论这种形式的放射治疗非常重要。
