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Proton radiotherapy in advanced malignant melanoma of the conjunctiva

  • Oncology
  • Published:
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Abstract

Background

The management of conjunctival melanoma is challenging and frequently ends in exenteration. The aim of this retrospective study was to evaluate the long-term results of proton beam radiation with regard to various clinical parameters.

Methods

Eighty-nine patients with extended conjunctival melanoma (≥T2) and multifocal bulbar located tumors (T1c/d) were treated consecutively with proton radiotherapy (dose 45 Gy). The following parameters were assessed: TNM stage, tumor origin, local recurrence, performance of exenteration, occurrence of metastases, overall survival, and potential complications. A time-to-event analysis was preformed to the primary endpoints: relapse, metastasis, exenteration, and death by use of Kaplan-Meier cumulative survival estimates and Cox proportional hazards regression that provides hazard ratios and 95% confidence intervals.

Results

The median follow-up time was 4.2 years (max. 21.7 years). Local recurrence and metastatic disease occurred in 33% and 16% of patients, respectively. Exenteration-free survival and overall survival tended to be worse in T3 melanoma. No association between tumor origin and local recurrence, metastatic disease, or overall survival was observed.

Main complications after proton radiotherapy were sicca-syndrome (30%), secondary glaucoma (11%), and limbal stem cell deficiency (8%).

Conclusions

In summary, proton radiotherapy in conjunctival melanoma is an effective alternative to exenteration, with a 5-year cumulative probability of eye preservation of 69%.

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Abbreviations

LSCD:

limbal stem cell deficiency

MMC:

Mitomycin C

PAM:

primary acquired melanosis

SD:

standard deviation

SE:

standard error

HR:

Hazard ratio

CI:

confidence interval

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Simone L. Scholz, Klaus-Peter Steuhl & Henrike Westekemper

  2. Centre Antoine-Lacassagne, 33 Avenue de Valombrose, 06100, Nice, France

    Joel Hérault & Juliette Thariat

  3. Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Andreas Stang

  4. Department of Epidemiology, School of Public Health, Boston University, Boston, USA

    Andreas Stang

  5. Department of Dermatology, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Klaus G. Griewank

  6. Dermapathologie bei Mainz, Nieder-Olm, Bahnhofstrasse 2B, 55268, Nieder-Olm, Germany

    Klaus G. Griewank

  7. Department of Ophthalmology, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany

    Daniel Meller

  8. Department of Radiation Therapy, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Wolfgang Sauerwein

Authors
  1. Simone L. Scholz
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Contributions

Technical development: W.S.; J.H. Patient treatment: S.L.S.; J.H.; D.M.; J.T.; K.-P.S.; H.W.; W.S. Data collection: S.L.S.; W.S.; J.H.; J.T.; D.M.; H.W. Data analysis: A.S.; S.L.S.; W.S. Data interpretation: S.L.S.; W.S.; A.S.; K.G.; H.W. Literature search: S.L.S.; W.S.; K.G.; A.S. Manuscript writing: all authors.

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Correspondence to Simone L. Scholz.

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The authors declare that they have no conflict of interest.

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The study was done with written patient informed consent in accordance with the tenets of the Declaration of Helsinki and the guidelines put forth by the ethics committee of the University of Duisburg-Essen, Germany.

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Informed consent was obtained from all individual participants included in the study.

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Scholz, S.L., Hérault, J., Stang, A. et al. Proton radiotherapy in advanced malignant melanoma of the conjunctiva. Graefes Arch Clin Exp Ophthalmol 257, 1309–1318 (2019). https://doi.org/10.1007/s00417-019-04286-2

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  • DOI: https://doi.org/10.1007/s00417-019-04286-2

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