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Proton therapy (PT) can spare the lens, reducing cataracts in uveal melanoma patients. A lens-sparing approach is feasible and improves tumor control, potentially revising radiation protection guidelines.

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Area of Science:

  • Ophthalmology
  • Radiation Oncology
  • Medical Physics

Background:

  • The lens is sensitive to radiation, and cephalic irradiation can cause cataracts.
  • Proton therapy (PT) offers precise dose deposition, potentially sparing the lens.

Purpose of the Study:

  • To investigate the relevance of a lens-sparing approach in preventing cataracts in uveal melanoma patients treated with PT.
  • To determine dose thresholds for radiation-induced cataracts.

Main Methods:

  • Prospective data collection from uveal melanoma patients undergoing PT.
  • Ophthalmological follow-up to assess lens opacifications and vision-impairing cataracts (VICs).
  • Dose-volume analysis using univariate/multivariate regressions to correlate radiation dose with VIC development.

Main Results:

  • 1696 patients treated with PT; 14.4% developed cataracts and 8.7% developed VICs after a median follow-up of 48 months.
  • Median lens doses were 1.1 GyRBE (mean) and 6.5 GyRBE (periphery).
  • No significantly increased VIC risk was observed below 10 GyRBE for irradiated lens volumes ≤5%.

Conclusions:

  • A lens-sparing approach using PT is feasible for uveal melanoma patients.
  • This approach reduces the need for cataract surgery and improves tumor control.
  • Findings suggest a potential reassessment of radioprotection rules for lens dose thresholds.