Good long-term visual outcomes of parapapillary choroidal melanoma patients treated with proton therapy: a comparative s
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ORIGINAL PAPER
Good long-term visual outcomes of parapapillary choroidal melanoma patients treated with proton therapy: a comparative study Alessia Pica . Damien C. Weber . Laureen Vallat . Ciara Bergin . Jan Hrbacek . Claude Schweizer . Leonidas Zografos . Ann Schalenbourg
Received: 31 March 2020 / Accepted: 9 September 2020 The Author(s) 2020
Abstract Purpose 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. Methods This 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 B 2.5 mm from the optic disc, largest tumor diameter B 17.9 mm, tumor thickness B 5.2 mm and available follow-up data for at least 5 years. Results Mean follow-up was 120.8 ± 48.8 months (54.0–295.0). Out of 310 patients, 64 (21%) maintained a VA B 0.2 logMAR (C 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 B 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. Conclusions Of 310 small- to medium-sized pcM patients successfully treated with PT, 21% retained a VA B 0.2 logMAR (C 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. Keywords Uveal melanoma Proton radiation therapy Optic nerve head Visual acuity
Introduction A. Pica (&) D. C. Weber J. Hrbacek Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland e-mail: [email protected] L. Vallat C. Bergin C. Schweizer L. Zografos A. Schalenbourg Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
Over the last decades, conservative radiation therapy has gradually replaced enucleation as the preferred treatment modality for small- to medium-sized choroidal melanoma. In 2006, the COMS-study confirmed that the 12-year metastatic death risk was identical for either treatment type [1]. Parapapillary choroidal melanoma (pcM) is often treated with
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external beam proton therapy (PT), rather than brachytherapy, to decrease the risk of a local recurrence through geographical
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