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Charged Particle Irradiation of Uveal Melanomas

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Albert and Jakobiec's Principles and Practice of Ophthalmology

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Abstract

Proton irradiation is the most widely used type of external beam irradiation for uveal melanomas. Highly localized and uniform radiation dose distributions are achieved with protons making it possible to treat large tumors and tumors near the optic nerve and/or fovea with some potential for vision retention. In the United States, the standard total dose is 70 Gy (RBE) delivered in five equal fractions for large and more peripheral tumors. A reduced total dose of 50 Gy (RBE) is now used to treat patients with small and medium tumors located near the optic disc or fovea. In Europe, the most common total dose used is 60 Gy (RBE).

Because of these advantageous properties, about one-third of patients retain visual acuity of 20/200 or better at 10 years after irradiation. However, vision threatening complications including neovascular glaucoma, maculopathy, and papillopathy can occur. The risk of radiation-related complications correlates with increasing tumor size and proximity to critical ocular structures.

Enucleation after proton irradiation is uncommon (12% at 10 years), but is sometimes recommended for recurrent tumors or when serious complications such as neovascular glaucoma or a blind, painful eye develop.

Although rates of local control approach 100% (10-year rate of recurrence is <5%) after proton irradiation, the risk of metastasis and death from uveal melanoma appears to be independent of the type of primary therapy; similar survival rates have been observed with protons compared to plaque brachytherapy and enucleation. The probability of developing metastasis exceeds 50% in patients with large tumors and those with high-risk tumor genetics (for example: class 2 gene expression profile, BAP1 mutation, or monosomy of chromosome 3). When metastasis occurs, the liver is the predominant site, and current therapies are ineffective in improving overall survival. Continued research to develop adjuvant therapies and better systemic therapies for individuals with metastatic disease is greatly needed.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Evangelos S. Gragoudas, Ivana K. Kim, Mary E. Aronow & Anne Marie Lane

Authors
  1. Evangelos S. Gragoudas
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  2. Ivana K. Kim
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  3. Mary E. Aronow
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  4. Anne Marie Lane
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Corresponding author

Correspondence to Evangelos S. Gragoudas .

Editor information

Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. No affiliation provided

    Joan Marie O’Brien

  2. No affiliation provided

    Evangelos S. Gragoudas

  3. No affiliation provided

    Dan Gombos

  4. No affiliation provided

    Mary E. Aronow

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Gragoudas, E.S., Kim, I.K., Aronow, M.E., Lane, A.M. (2022). Charged Particle Irradiation of Uveal Melanomas. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_249

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  • DOI: https://doi.org/10.1007/978-3-030-42634-7_249

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-42633-0

  • Online ISBN: 978-3-030-42634-7

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