Quantitative echography in primary uveal melanoma treated by proton beam therapy

Abstract Objective To describe the dynamics of thickness and internal reflectivity after proton beam therapy (PBT) in uveal melanoma. Participants One hundred and ninety-eight consecutive patients with choroidal or ciliary body melanoma treated by PBT were retrospectively considered. Methods The post-PBT follow-up included ophthalmologic examination, retinography, and B and A modes of standardized echography every 6 months. A total of 1393 examinations were performed. We take into account 4 tumour categories according to the seventh TNM classification. Results Before PBT, tumour thickness ranged from 1.5 to 12.5 mm with a mean of 5.9 mm. Its decrease after radiotherapy was best fitted by the sum of a first-order exponential decay and a constant with a decay half-life of 15 months. Based on the fit, tumour thickness stabilized on a constant value representing, on average, 47% of the initial value. Mean internal reflectivity before PBT was 68%. The dynamics of the reflectivity were best fitted by an exponential and a constant, with rise half-life of 11 months, and stability value of 87%. Conclusions We found that ultrasonographic dynamics of uveal melanoma treated by PBT resembles a function composed of the sum of a constant and a first-order exponential, as previously noted in studies on brachytherapy. Interestingly, after PBT, because of its shorter half-life, internal reflectivity has a faster dynamic response than thickness in large tumours, suggesting that increase of internal reflectivity is a more sensitive indicator of early response to therapy in larger tumours.