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Salvage proton beam therapy for recurrent iris melanoma: outcome and side effects

  • Oncology
  • Published:
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Abstract

Purpose

This study aims to analyze the effect of salvage proton beam therapy for the treatment of recurrent iris melanoma.

Method

In this clinical case series, we retrospectively analyzed the data of eight patients who underwent proton beam therapy of the whole anterior segment as salvage therapy between 2000 and 2016 for recurrent iris melanoma after resection, ruthenium brachytherapy, or sector proton beam therapy. Two patients received salvage proton beam therapy for repeated tumor relapse. All patients were observed and prepared for proton beam therapy at the Charité and irradiated at the Helmholtz-Zentrum Berlin where they received 50 cobalt Gray equivalents (CGE) in four daily fractions. We investigated survival rates and ocular outcome.

Results

Median follow-up after salvage proton beam therapy was 39 months. No local recurrence was detected during follow-up. One patient died from hepatic metastases 5.5 years after salvage therapy. Secondary glaucoma occurred in seven out of eight patients during follow-up. Two patients had chronic corneal erosion and two other patients presented with corneal decompensation, necessitating Descemet membrane endothelial keratoplasty (DMEK), and perforating keratoplasty. Median visual acuity was 0.2 logMAR before salvage proton beam therapy and 0.7 logMAR at the end of follow-up.

Conclusion

Whole anterior segment salvage proton beam therapy has effectively controlled recurrent iris melanoma in our patients, but has been associated with a high incidence of radiation-induced corneal impairment and secondary glaucoma requiring extensive secondary treatment.

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Authors and Affiliations

  1. Augenklinik/Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    Aline I. Riechardt, Julian P. Klein, Dino Cordini, Jens Heufelder, Matus Rehak, Ira Seibel & Antonia M. Joussen

  2. Berlin Protonen at the Helmholtz-Zentrum Berlin für Materialien und Energie, Berlin, Germany

    Dino Cordini & Jens Heufelder

Authors
  1. Aline I. Riechardt
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  2. Julian P. Klein
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  3. Dino Cordini
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  4. Jens Heufelder
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  5. Matus Rehak
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  6. Ira Seibel
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  7. Antonia M. Joussen
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Contributions

All authors substantial contributed to the conception or design of the work or acquisition, analysis, or interpretation of data for the work. All authors drafted the work or critically revised the work for important intellectual content, and finally approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Aline I. Riechardt.

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Conflict of interest

A.I. Riechardt: reimbursements of travel expense: EURETINA 2015/Novartis. J.P. Klein states that there are no conflicts of interest. D. Cordini states that there are no conflicts of interest. J. Heufelder states that there are no conflicts of interest. M. Rehak: board membership: Novartis, Allergan, Alimera, speaker honoraria: Novartis Bayer, Allergan, Alimera. I. Seibel states that there are no conflicts of interest. Prof. A. M. Joussen states that there are no conflicts of interest. The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review board of the Charité-Universitätsmedizin Berlin, Berlin, Germany, and was in accordance with the tenets of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Riechardt, A.I., Klein, J.P., Cordini, D. et al. Salvage proton beam therapy for recurrent iris melanoma: outcome and side effects. Graefes Arch Clin Exp Ophthalmol 256, 1325–1332 (2018). https://doi.org/10.1007/s00417-018-3929-5

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  • DOI: https://doi.org/10.1007/s00417-018-3929-5

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