Purpose

To report on the clinical characteristics and outcomes for patients with iris melanoma using proton therapy.

Design

Retrospective study.

Participants

One hundred seven patients with iris melanoma from 3 regional ophthalmologic centers.

Methods

A retrospective study was conducted for iris melanoma patients from 3 regional ophthalmologic centers referred to and treated at a single proton therapy facility between 1996 and 2015.

Main Outcome Measures

At each follow-up visit, examinations included measurement of best-corrected VA, slit-lamp, examination, indirect ophthalmoscopy, and ultrasound biomicroscopy.

Results

With a median follow-up of 49.5 months, 5 of 107 patients experienced a local relapse within a median of 36.3 months. The cumulative incidence of relapse was 7.5% at 5 years. All 5 patients showed involvement of the iridocorneal angle (P = 0.056). Diffuse iris melanoma showed a higher risk of relapse (P = 0.044). Four patients showed out-of-field relapse and 1 showed angular relapse. Three patients were retreated with proton therapy, whereas 2 other patients, one with T1b disease and another with diffuse T3 disease, underwent secondary enucleation. None of the patients experienced metastases nor died of iris melanoma. Vision improved in 59.4% of patients (n = 60/101). However, cataracts occurred in 57.4% of the 54 patients (n = 31) without cataract or implant at diagnosis. Secondary glaucoma was reported in 7.6% of the patients (n = 8), uveitis in 4.7% (n = 5), and hyphema in 3.7% (n = 4). All but 5 cases of complications were mild, transient, and not sight limiting after treatment. Five cases of glaucoma, including 1 with uveitis, were severe and associated with visual deterioration.

Conclusions

Proton therapy showed efficacy and limited morbidity in iris melanomas.

中文翻译：

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质子束疗法治疗虹膜黑色素瘤107例

目的

报告质子治疗虹膜黑色素瘤患者的临床特征和预后。

设计

回顾性研究。

参加者

来自3个区域眼科中心的107例虹膜黑色素瘤患者。

方法

在1996年至2015年之间，对来自3个地区眼科中心的虹膜黑色素瘤患者进行了回顾性研究，这些患者在一家质子治疗机构接受了转诊并接受了治疗。

主要观察指标

每次随访时，检查均包括最佳矫正视力的测量，裂隙灯，检查，间接检眼镜和超声生物显微镜检查。

结果

中位随访49.5个月，在107名患者中有5名在中位36.3个月内经历了局部复发。5年时复发的累积发生率为7.5％。所有5例患者均显示虹膜角膜角受累（P  = 0.056）。弥漫性虹膜黑色素瘤复发的风险较高（P = 0.044）。4例患者表现出视野外复发，1例患者出现角膜复发。3名患者接受了质子治疗，而其他2名患者，其中一名患有T1b疾病，另一名患有弥漫性T3疾病，则进行了第二次摘除术。没有患者发生转移或死于虹膜黑色素瘤。59.4％的患者视力得到改善（n = 60/101）。然而，在诊断时没有白内障或植入的54例患者（n = 31）中有57.4％发生了白内障。据报告，继发性青光眼的患者为7.6％（n = 8），葡萄膜炎为4.7％（n = 5），前房积血为3.7％（n = 4）。除5例外，其他所有并发症均为轻度，短暂性，治疗后无视力障碍。5例青光眼严重，包括1例葡萄膜炎，并伴有视力下降。

结论

质子疗法在虹膜黑色素瘤中显示出疗效和有限的发病率。