Oncologic and visual outcomes after postoperative proton therapy of localized conjunctival melanomas.

Abstract

INTRODUCTION:

conjunctival melanomas have high local relapse rates. Oncologic and visual outcomes can be improved with proton therapy and no-touch surgery.

MATERIAL AND METHODS:

a monocentric retrospective study of consecutive patients treated with surgery and proton therapy for conjunctival melanoma was conducted. Proton therapy was performed to a total dose of 45 Grays physical dose delivered in eight fractions over two weeks.

RESULTS:

Ninety-two patients were included. The mean age was 63-year-old. 65.2% of patients had primary acquired melanosis. The mean tumor thickness and diameter was 2.5 mm and 7.0 mm respectively. The clinical stage was T1 in 71.6% of cases, with a quadrangular involvement of more than 90° in 69% of cases. Conjunctival melanomas were of epithelioid cell-type in 40% of cases. Mean follow-up was 4.7 years. Five-year local failure rate was 33.2%. Of 25 local recurrences, 14 were marginal/out-of-field, 4 in-field, others were undetermined. First surgery at expert center resulted in 24.3% of local failure at 5 years versus 38.7% if performed elsewhere (p = 0.41). Salvage exenteration was performed in 13 patients. Tumor stage and quadrangular involvement were significant factors for local failure. Five-year progression-free survival and cause-specific death rates were 61.5 and 3.6%. Stage and epithelioid type were associated with poorer progression-free survival. Trophic toxicity occurred in 22.9% of patients and was treated locally, with grafts in 7 patients. Glaucoma and cataract occurred in 13 and 22 patients respectively. Prognostic factors for visual deterioration were age, tumor extent (multifocality, quadrangular involvement > 180°) and cryotherapy.

CONCLUSIONS:

5-year local failure rate after postoperative proton therapy for conjunctival melanoma was of 33.2%. Radiation-induced complications were overall manageable.

• Authors: Juliette Thariat, Julia Salleron, Celia Maschi, Edouard Fevrier, Sandra Lassalle, Lauris Gastaud, Stephanie Baillif, Audrey Claren, Florent Baumard, Joel Herault, Jean Pierre Caujolle
• Journal: Radiation oncology (London, England) (Radiat Oncol) Vol. 14 Issue 1 Pg. 239 (Dec 27 2019) ISSN: 1748-717X [Electronic] England
• PMID: 31881977 (Publication Type: Journal Article)

Topics

• Aged
• Conjunctival Neoplasms (mortality, pathology, radiotherapy)
• Female
• Humans
• Male
• Melanoma (mortality, pathology, radiotherapy)
• Middle Aged
• Neoplasm Recurrence, Local (mortality, pathology, radiotherapy)
• Postoperative Care
• Prognosis
• Proton Therapy (mortality)
• Retrospective Studies
• Survival Rate