Proton therapy for uveal melanoma (preliminary results)

Purpose. To present preliminary results of treatment of uveal melanoma with proton therapy using the scanning pencil beam technique. Material and methods. In this study we included 7 patients (female) with uveal melanoma aged 23 to 51 years. The tumor was localized in the choroid (4), ciliochoroidal (2) and iridociliary (1) zones. All patients received proton therapy in the hypofractionation mode at a total dose of 49 Gy in 7 fractions (BED0,6=620 Gy; EQD2=143 Gy). The follow-up period for patients ranged from 6 to 33 months. Results. In the early post-radiation period, a radiation reaction was observed in the form of skin erythema (2 patients), exudative retinal detachment (3 patients). Late complications were observed as neovascular glaucoma, which developed 6–11 months after the start of treatment in 4 patients, maculopathy (1 patient), dry eye syndrome with madarosis (3 patients). All treated patients had a slow rate of tumor regression, as a rule, the tumor began to regress after 6–8 months from the start of treatment. Complete regression was observed in 2 patients with T3aN0M0 stages of the process for a period of 24 months, the rest showed partial regression of the tumor. Conclusion. The obtained preliminary results of proton therapy using the scanning pencil beam technique are very encouraging in the treatment of large uveal melanomas and open a new perspective in their successful treatment. The use of photodynamic therapy with chlorin drugs should probably be considered as an adjuvant therapy, the effect of which will accelerate the rate of regression and reduce the incidence of complications. Key words: choroidal melanoma, proton therapy, brachytherapy, uveal melanoma, ophthalmo-oncology, choroidal melanoma treatment