15 years experience with helium ion radiotherapy for uvealmelanoma
Purpose: To review the long-term experience of helium iontherapy as a therapeutic alternative to enucleation for uveal melanoma,particularly with respect to survival, local control, and morbidity.Methods and Materials: 347 patients with uveal melanoma were treated withheluim ion RT from 1978-1992. A nonrandomized dose-searching study wasundertaken, with doses progressively reduced from 80 GyE in fivefractionsto 48 GyE in four fractions, given in 3-15 days, mean of 7days. Results: Local control was achieved in 96 percent of patients, withno difference in the rate of local control being seen at 80, 70, 60, or50 GyE in five fractions. At the lowest dose level of 48 GyE in fourfractions, the local control rate fell to 87 percent. Fifteen of 347patients (4 percent) had local regrowth in the eye requiring enucleation(12 patients), laser (1 patient) or reirradiation (2 patients). The timeof appearance of local regrowth ranged from 4 months to 5 yearsposttreatment, with 85 percent occurring within 3 years. Of the 347patients, 208 are alive as of May 1, 1997. The median follow up of allpatients is 8.5 years, range 1-17 years. Kaplan-Maier (K-M) survival is80 percent at 5 years, 76 percent at 10 years, and 72 percent at 15 yearsposttreatment. Patients with tumors not involving the ciliary body have a15-year K-M survival of 80 percent. The results for patients whose tumorsinvolved the ciliary body are poor, with a 15-year K-M survival of 43percent. Seventy-five percent of patients with tumors at least 3.0 mmfrom the fovea and optic nerve, and initial ultrasound height less than6.0 mm, retained vision of 20/200 or better posttreatment. Patients withtumors larger than 6 mm in thickness, or with tumors lying close to theoptic nerve or fovea, have a reduced chance of retaining useful vision.The enucleation rate is 19 percent, 3 percent for local failure and 16percent because of complications of the helium RT, particularlyneovascular glaucoma, which occurred in 35 percent of patients.Conclusions: Local control and retention of the eye are excellent.Complications of therapy reduce vision and eye preservation. Twenty-fourpercent of patients manifested distant metastases 6 to 146 monthsposttreatment, mean of 43 months, median of 36 months. Late-appearingdistant metastases do not appear to be caused by persistent tumor in theeye. The risk of metastases is high for patients with tumors greater than7 mm in initial ultrasound height (37 percent), anterior tumors involvingthe ciliary body (47 percent), and in those with local failure (53percent). Patients with tumors not involving the ciliary body and initialdimensions less than 10 mm had only an 8 percent chance of death frommelanoma. A search for effective adjuvant therapy is needed for patientsat high risk of metastases (large tumors, ciliary body involved, localregrowth in eye).
- Research Organization:
- Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)
- Sponsoring Organization:
- USDOE Director, Office of Science; National Institutes ofHealth
- DOE Contract Number:
- DE-AC02-05CH11231
- OSTI ID:
- 900625
- Report Number(s):
- LBNL-40810
- Journal Information:
- International Journal of Radiation Oncology, Biology,Physics, Vol. 39, Issue 5; Related Information: Journal Publication Date: 1997
- Country of Publication:
- United States
- Language:
- English
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