Abstract
Purpose
To evaluate the incidence, risk factors, and dosages of proton beam therapy associated with cataract development, and long-term visual outcomes after treatment of uveal melanoma.
Methods
All patients receiving primary proton beam therapy for uveal melanoma between 1998 and 2008 with no signs of cataract before irradiation were included. A minimum follow-up of 12 months was determined. Exclusion criteria included all applied adjuvant therapies such as intravitreal injections, laser photocoagulation, tumor resections, or re-irradiation. For subgroup analysis, we included all patients who underwent brachytherapy between 1998 and 2008 for uveal melanoma, considering the above mentioned inclusion and exclusion criteria.
Results
Two hundred and fifty-eight patients matched our inclusion criteria. Median follow-up was 72.6 months (12.0-167.4 months). Of these 258 patients, 71 patients (66.3 %) presented with cataract after 31.3 months (0.7–142.4 months), of whom 35 (20.4 %) required surgery after 24.2 (0.7–111.1 months) to ensure funduscopic tumor control. Kaplan–Meier estimates calculated a risk for cataract of 74.3 % after 5 years. There was no increase in metastasis or local recurrence in these patients. Patient’s age was the sole independent statistically significant risk factor for cataract development. The probability of cataract occurrence significantly increased with doses to lens exceeding 15–20 CGE. Neither the appearance of cataract nor cataract surgery influenced long-term visual outcome.
Conclusion
Cataract formation is the most frequent complication after irradiation. There is no benefit vis-a-vis brachytherapy with regard to cataract development. Data indicate a dose–effect threshold of 0.5 CGE for cataractogenesis, with significantly increasing risk above a dose of 15 CGE. Furthermore, cataract surgery can be performed without an increased risk for metastasis.
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Acknowledgments
Statistical analysis was performed by Dr. Ulrich Gauger, medical statistician, Berlin, Germany.
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Prof. Dr. A. M. Joussen and PD Dr. M. Rehak report personal fees from Bayer, personal fees from Novartis, and personal fees from Allergan, outside the submitted work. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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Seibel, I., Cordini, D., Hager, A. et al. Cataract development in patients treated with proton beam therapy for uveal melanoma. Graefes Arch Clin Exp Ophthalmol 254, 1625–1630 (2016). https://doi.org/10.1007/s00417-016-3356-4
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DOI: https://doi.org/10.1007/s00417-016-3356-4