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. 2021 Dec 23;6(1):e000683.
doi: 10.1136/bmjophth-2020-000683. eCollection 2021.

Proton beam radiation for iris melanoma: case series and review of literature

Jasmine Alexandra Hauzinger  1 , Georgios Blatsios  2 , Gertrud Haas  1 , Claus Zehetner  1 , Luisa Velez-Escola  1 , Yvonne Nowosielski  1 , Christof Seifarth  1 , Teresa Rauchegger  1 , Bernhard Haider  3 , Nikolaos E Bechrakis  4
Affiliations

Proton beam radiation for iris melanoma: case series and review of literature

Jasmine Alexandra Hauzinger et al. BMJ Open Ophthalmol. .

Abstract

Objective: Purpose of this study is to analyse the visual outcomes, the complication and eye retention rate as well as tumour control data of patients treated with proton beam radiation therapy (PBRT) for iris melanoma.

Methods: Retrospective case series and review based on patients' records. All tumours were categorised according to the American Joint Committee of Cancer staging criteria for primary iris melanoma und underwent either sectorial or whole anterior segment PBRT.

Results: Thirteen cases were identified of which five received PBRT of the whole anterior segment and eight received sectorial PBRT. Local tumour control after a mean follow-up of 25 months was 92%. Complications after PBRT included cataract (46%), secondary glaucoma (31%), superficial keratitis (15%) and madarosis (8%). Complications were more common in patients necessitating irradiation of the entire anterior segment than in patients which received sectorial irradiation. Eye retention was achieved in all cases. No statistically significant difference in the mean best corrected visual acuity (BCVA) and intraocular pressure (IOP) was found before and after treatment. Comparison of mean BCVA and IOP between different treatment groups (complete anterior segment vs sectorial irradiation) at the last follow-up visit were also not significantly different. No patient developed metastatic disease during follow-up.

Conclusion: PBRT is a safe and vision preserving therapeutic modality for iris melanoma. Complete irradiation of the anterior segment is associated with higher complication rates.

Keywords: iris; neoplasia.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
T1a tumour before (A) and after (B) sectorial PBRT. T1b tumour with seeding cells over the entire iris before (C) and after (D) PBRT of the whole anterior segment. Amelanotic T1a tumour before (E) and after (F) sectorial PBRT. T4a tumour before (G) and after (H) PBRT of the whole anterior segment. PBRT, proton beam radiation therapy.
Figure 2
Figure 2
Postirradiation complications and their management. TCP, transscleral cyclophotocoagulation; TE, trabeculectomy.
Figure 3
Figure 3
Comparison of complications between complete and sectorial PBRT. PBRT, proton beam radiation therapy.
Figure 4
Figure 4
T1B tumour before sectorial PBRT (A). Second iris melanoma in non-irradiated area (arrow) (B). PBRT, proton beam radiation therapy.
See this image and copyright information in PMC

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