Proton beam therapy for the treatment of uveal melanoma in Scotland

Background and aims In Scotland, uveal melanomas are primarily treated with eye-preserving modalities with a low primary enucleation rate. Proton beam therapy (PBT) is reserved for those not suitable for brachytherapy. The authors9 aim was to review the outcome of Scottish patients undergoing treatment for uveal melanoma with PBT. Method All ciliary body or choroidal melanomas treated initially with PBT between 1 January 1993 and 30 March 2008 were identified. Data were gathered from retrospective review of case notes, database information, PBT planning data, ultrasound and pathology reports. Results 147 patients were identified. The mean age was 62.3 years, 94.6% were choroidal melanomas. 97.8% of all treated melanomas were of medium or large size. Enucleation during follow-up occurred in 22.4%. Mean time to this was 23.8 months and main reasons were suspected recurrence (48%) and neovascular glaucoma (42%). Metastatic death occurred in 9.5%, the mean time to this was 28.9 months. The actuarial 5-year eye retention rate was 71.3% and disease-specific survival rate was 87.7%. Conclusion PBT is reserved for the treatment of mainly medium-sized and large-sized uveal melanomas in Scotland. The eye retention and disease-specific survival rates confirm its suitability as an eye-preserving primary treatment in these patients. It is evident that PBT is a conservative treatment option for uveal melanoma, including those of larger size.