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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Proton therapy for uveal melanoma in 43 juvenile patients: long-term results
Aleksandra Petrovic1, Ciara Bergin1, Ann Schalenbourg1
1Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland.
Insights
Juvenile patients with uveal melanoma (UM) treated with proton beam radiotherapy (PBRT) show significantly lower metastasis rates and better survival than adults. PBRT offers comparable eye retention and vision outcomes for both age groups, validating it as a suitable treatment for young patients.
Area of Science:
- Ophthalmology
- Radiation Oncology
- Pediatric Oncology
Background:
- Uveal melanoma (UM) is a rare eye cancer.
- Proton beam radiotherapy (PBRT) is a treatment option for UM.
- Outcomes in juvenile patients are less understood than in adults.
Purpose of the Study:
- To compare metastatic rates, survival, eye retention, and visual outcomes in juvenile versus adult UM patients treated with PBRT.
- To evaluate the efficacy and safety of PBRT in pediatric UM cases.
Main Methods:
- Retrospective case-factor matched control study.
- Compared 43 juvenile patients (<21 years) with 129 matched adult controls (>21 years).
- Matched controls based on tumor size and location; analyzed demographics, clinical characteristics, metastasis, survival, and visual acuity.
Main Results:
- Juvenile UM patients had significantly lower 10-year metastasis rates (11% vs. 34%) and better relative survival (93% vs. 65%) compared to adults.
- Eye retention rates and visual acuity were comparable between juvenile and adult groups post-PBRT.
- Metastasis occurred in 14% of juveniles and 27% of adults; enucleation rates were 9.3% for juveniles and 16% for adults.
Conclusions:
- PBRT demonstrates superior metastatic and survival outcomes for juvenile UM patients compared to adults.
- PBRT is a safe and effective conservative treatment for UM in patients under 21.
- Juvenile and adult eyes exhibit similar responses to PBRT regarding retention and vision.
Purpose:
To examine the metastatic and survival rates, eye retention probability, and the visual outcomes of juvenile patients after proton beam radiotherapy (PBRT) for uveal melanoma (UM).
Design:
Retrospective case-factor matched control study.
Participants And Controls:
Forty-three patients younger than 21 years treated with PBRT for UM were compared with 129 matched adult control patients.
Methods:
Information on patient demographics and clinical characteristics were recorded before and after treatment from patients' files. The control group was composed of adult patients (>21 years) matched for tumor size (largest tumor diameter, ±2 mm; height, ±2 mm) and anterior margin location (iris, ciliary body, pre-equatorial or postequatorial choroid). For each juvenile patient, 3 adults were selected.
Main Outcome Measures:
Comparing outcomes of juvenile and adult patients in terms of metastatic and eye retention rates using the log-rank statistic, relative survival using the Hakulinen method, as well as their visual outcomes.
Results:
Forty-three juvenile and 129 control cases were reviewed. The metastatic rate at 10 years was significantly lower in juvenile UM patients than in adult controls (11% vs. 34%; P <0.01), with an associated relative survival rate of 93% versus 65% (P = 0.02). Six juvenile patients (14%) demonstrated metastases. One patient underwent enucleation because of a presumed local tumor recurrence and 4 additional patients underwent enucleation because of complications (9.3%). In the adult control group, 27% (n = 35) of matched patients demonstrated metastases, there were 2 cases of local recurrence, and 16% (n = 21) underwent enucleation because of complications. A visual acuity of more than 0.10 was maintained in most cases, without any significant differences before or after treatment observed between both groups.
Conclusions:
After PBRT, metastatic and survival rates are significantly better for juvenile than for adult patients with UM. Clinically, juvenile and adult eyes react similarly to PBRT, with patients having a comparable eye retention probability and maintaining a useful level of vision in most cases. This is the largest case-control study of proton therapy in juvenile eyes to date and further validates PBRT as an appropriate conservative treatment for UM in patients younger than 21 years.
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