Predictive risk factors for radiation retinopathy and optic neuropathy after proton beam therapy for uveal melanoma

Graefes Arch Clin Exp Ophthalmol. 2016 Sep;254(9):1787-92. doi: 10.1007/s00417-016-3429-4. Epub 2016 Jul 4.

Abstract

Purpose: This study was performed in order to evaluate the incidence of radiation retinopathy and optic neuropathy occurring after proton beam therapy for uveal melanoma.

Methods: Included in this study were all patients who had been treated with primary proton beam therapy for uveal melanoma at the oncology service between May 1998 and June 2014 with a minimum follow-up of 12 months. Excluded were all patients who underwent re-irradiation, or vitrectomy due to exudative retinal detachment or for tumor-resection.

Results: During this period, 1127 patients matched the inclusion criteria, of whom 768 (68.1 %) and 463 (41.0 %) developed radiation retinopathy and optic neuropathy after a median time of 18.9 months (2.0-99.84 months) and 19.8 months (0.2-170.4 months), respectively. Mean follow-up was 53.4 months (12-170.4 months). Included were 558 men (49.5 %) and 569 women (50.5 %). Mean age was 61 years (16-89 years). Visual acuity slightly decreased from initial levels of 0.3 logMAR-0.4 logMAR in patients without developing any radiation-induced complication but severely decreased to 1.0 logMAR or 1.5 logMAR in the case of developing radiation retinopathy only or optic neuropathy, respectively. Independent risk factors for radiation retinopathy were a centrally (<2.5 mm from sensitive structures) located tumor or a thick tumor located more than 2.5 mm from sensitive structures, while those for radiation optic neuropathy comprised a short distance and applied dose to the optic disk.

Conclusion: The risk for radiation retinopathy is higher in central uveal melanoma. Mid-/peripheral tumors are at high risk for radiation retinopathy and maculopathy if presenting with increased thickness.

Keywords: Proton beam therapy; Radiation retinopathy; Tumor resection; Uveal melanoma.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Germany / epidemiology
  • Humans
  • Incidence
  • Magnetic Resonance Imaging
  • Male
  • Melanoma / diagnosis
  • Melanoma / mortality
  • Melanoma / radiotherapy*
  • Middle Aged
  • Optic Nerve Diseases / diagnosis
  • Optic Nerve Diseases / epidemiology
  • Optic Nerve Diseases / etiology*
  • Proton Therapy / adverse effects*
  • Radiation Injuries / diagnosis
  • Radiation Injuries / epidemiology
  • Radiation Injuries / etiology*
  • Retinal Diseases / diagnosis
  • Retinal Diseases / epidemiology
  • Retinal Diseases / etiology*
  • Retrospective Studies
  • Survival Rate / trends
  • Time Factors
  • Tomography, Optical Coherence
  • Uveal Neoplasms / diagnosis
  • Uveal Neoplasms / mortality
  • Uveal Neoplasms / radiotherapy*
  • Visual Acuity
  • Young Adult

Supplementary concepts

  • Uveal melanoma