{Reference Type}: Journal Article
{Title}: Proton beam therapy for presumed and confirmed iris melanomas: a review of 36 cases.
{Author}: Rahmi A;Mammar H;Thariat J;Angellier G;Herault J;Chauvel P;Kodjikian L;Denis P;Grange JD;
{Journal}: Graefes Arch Clin Exp Ophthalmol
{Volume}: 252
{Issue}: 9
{Year}: Sep 2014
{Factor}: 3.535
{DOI}: 10.1007/s00417-014-2735-y
{Abstract}: <B>BACKGROUND: </B>To report the clinical features and outcomes of iris melanomas treated by proton beam therapy.<BR><B>METHODS: </B>A retrospective study was conducted at the Croix-Rousse University Hospital of Lyon, Department of Ophthalmology, in 36 patients treated by proton beam therapy for presumed (n = 29) and confirmed (n = 7) iris melanomas between July 1997 and October 2010. Ciliary body melanomas with iris involvement were excluded. The patients' mean age was 54.4 years (range, 22-82 years). The average tumor diameter was 3.8 mm (range, 2.5-8.0). The iridocorneal angle was invaded by the tumor in 47% of cases (n = 17), the ciliary body in 17% of cases (n = 6), and the sclera in 3% (n = 1). Raised intraocular pressure was present before treatment in 11.1 % of cases (n = 4). Tumor biopsy was performed in 19% of cases (n = 7). Four patients had undergone an initial incomplete surgical excision of tumor before radiotherapy. Surgical preparation of the eye with tantalum ring positioning had been performed in all cases 3-4 weeks before irradiation. The prescribed dose was 60 Cobalt Gray Equivalent (CGE) of proton beam radiotherapy delivered in four fractions on four consecutive days.<BR><B>RESULTS: </B>The median follow-up was 50 months (mean 60.5, range 15-136). One patient (2.7%) was lost to follow-up. None of the patients showed tumor progression, local recurrence, or metastasis. None of the patients required secondary enucleation. Cataract was developed in 62% of patients, glaucoma in two cases (6%) after irradiation, and hyphema with the aggravation of pre-existing glaucoma in one patient. No patients developed neovascular glaucoma.<BR><B>CONCLUSIONS: </B>Proton beam therapy appears to be the treatment of choice for the conservative treatment of iris melanomas with excellent tumor control and an acceptable rate of complications. Longer follow-up studies on a larger series is necessary to consolidate these results.