Proton beam radiotherapy for uveal melanoma

Abstract

Proton beam radiotherapy for uveal melanoma can be administered as primary treatment, as salvage therapy for a recurrent tumor, as neoadjuvant therapy prior to surgical resection, or as adjuvant therapy after surgical resection. Of all eye-conserving forms of uveal melanoma treatment, proton beam is associated with the lowest overall risk of local tumor recurrence. The physical properties of proton beams make it possible to deliver high-radiation doses to tumors with relative sparing of adjacent tissues from collateral damage. The chances of survival, ocular conservation, visual preservation, and avoidance of iatrogenic morbidity depend greatly on the tumor size, location, and extent. When treating side effects and/or complications, it is helpful to consider whether the etiology is collateral damage to healthy ocular tissues, such as the optic disc, or exudation and release of angiogenic factors from the irradiated tumor, possibly resulting in neovascular glaucoma (‘toxic tumor syndrome’). As with any therapy, it is important to treat not only the tumor but the patient, addressing all needs and concerns with appropriate psychological counseling.

KEYWORDS:

• Ocular melanoma
• uveal melanoma
• choroidal melanoma
• ciliary body melanoma
• iris melanoma
• proton beam radiotherapy
• charged particle therapy
• globe-conserving therapy

ORCID

Armin R Afshar http://orcid.org/0000-0002-2989-7558

Inder K Daftari http://orcid.org/0000-0001-8336-4042