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Failure of choroidal melanoma to respond to helium ion therapy
Abstract:
Helium ion irradiation is a promising alternative therapy for choroidal melanoma. In short-term follow-up (less than 5 years), more than 90% (18/19) of treated patients demonstrated tumor regression. We had to enucleate five eyes after helium ion therapy either because of continued tumor growth (four patients) or other complications (one patient). Two melanomas continued to grow and seemed to be radioresistant. In two other tumors it retrospectively seemed that the entire lesion was not inside the radiation field. In one patient total retinal detachment and glaucoma developed; enucleation was performed because of a painful eye. Metastatic disease developed in no patients. The treatment failures emphasize that there are a number of unresolved issues regarding the use of charged-particle irradiation in the treatment of melanoma. Further studies must be performed to answer these questions and better delineate the use of these newer forms of therapy.
Insights
Helium ion therapy shows promise for choroidal melanoma, with over 90% tumor regression in short-term follow-up. However, further research is needed to address treatment failures and optimize charged-particle irradiation for melanoma.
Area of Science:
- Ophthalmology
- Radiation Oncology
- Medical Physics
Background:
- Choroidal melanoma is a rare intraocular malignancy.
- Helium ion irradiation is an emerging therapeutic modality for choroidal melanoma.
- Evaluating the efficacy and safety of helium ion therapy is crucial.
Observation:
- Short-term follow-up (less than 5 years) in 19 patients treated with helium ion therapy showed tumor regression in over 90% (18/19).
- Five eyes required enucleation due to persistent tumor growth (4 patients) or complications (1 patient).
- No metastatic disease was observed in any treated patients.
Findings:
- Two melanomas exhibited radioresistance and continued to grow post-treatment.
- Inadequate radiation field coverage was identified retrospectively in two cases.
- One patient developed retinal detachment and glaucoma, necessitating enucleation.
Implications:
- Helium ion irradiation demonstrates significant potential for choroidal melanoma treatment.
- Treatment failures highlight the need for further investigation into optimal dosimetry and patient selection.
- Continued research is essential to refine charged-particle therapy protocols for ocular tumors.