Proton radiation therapy for medium and large choroidal melanoma: preservation of the eye and its functionality

Int J Radiat Oncol Biol Phys. 2001 Mar 15;49(4):1053-9. doi: 10.1016/s0360-3016(00)01430-9.


Purpose: Evaluation of efficacy and safety of proton radiation therapy (PRT) for medium- and large-size choroidal melanoma with focus on preservation of the eye and its function.

Methods: Retrospective review of 78 patients with 60 medium and 18 large-size choroidal melanomas at a median follow-up of 34 months.

Results: The 5-year data for local control, metastases-free survival, and disease-specific survival were estimated to be 90.5 +/- 3.7%, 76.2 +/- 6.7%, and 75.6 +/- 7.6%, respectively. Eye preservation was achieved in 75.3% of patients, with useful (better than 20/200) visual acuity (VA) in 49.1% of surviving patients. Both local failure and complications led to enucleation. Prognosticators were tumor close to the optic disc (p = 0.003), large tumors involving the ciliary body (p = 0.041), and local failure (p < 0.001). Prognostic factors for VA following PRT were initial VA (p = 0.001), doses to optic disc (p = 0.001) and fovea (p = 0.022) higher than 35 CGE (Cobalt Gray equivalent), tumor close to the optic disc (p = 0.034), and retinal detachment (p < 0.001). Tumor basis diameter was significantly related to metastases free survival (p = 0.02), overall survival (p = 0.033), and disease specific survival (p = 0.017), but did not impair local tumor control, rate of enucleation, and VA.

Conclusion: The present data suggest that PRT is an effective and safe treatment for medium and large size choroidal melanoma. PRT can preserve the eye and its function in a reasonable percentage of patients. Further evaluation in controlled clinical trials comparing PRT to plaque radiotherapy and enucleation is required.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Choroid Neoplasms / pathology
  • Choroid Neoplasms / radiotherapy*
  • Eye Enucleation
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Melanoma / pathology
  • Melanoma / radiotherapy*
  • Middle Aged
  • Prognosis
  • Proton Therapy*
  • Retrospective Studies
  • Survival Analysis
  • Visual Acuity


  • Protons