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Proton Irradiation of Choroidal Melanomas: Preliminary Results

Proton Irradiation of Choroidal Melanomas: Preliminary Results Abstract • Choroidal malignant melanomas in nine patients were treated with proton beam irradiation at the Harvard Cyclotron Laboratory, Cambridge, Mass. Each patient received five proton beam treatments in eight to ten days, totaling 4,730 to 8,570 rads at the tumor. No complications occurred during the treatment or followup period, which, at the time of this writing, ranges from one to 24 months, with an average of 12 months. No further growth of the tumor has been observed in any patient. Different signs of tumor regression have been noted. Resolution of the serous retinal detachments that accompanied some tumors is the earliest finding. Pigment changes over the surface of the tumor and adjacent pigment epithelium is a usual initial tumor response. Fluorescein angiography initially showed decreased leakage of dye; later, destruction of the tumor's vasculature and elimination of fluorescein leakage became evident. Only large choroidal vessels remained patent. Ultrasonography revealed decreased height of the tumors postirradiation, and the radioactive phosphorus (32P) uptake test, repeated in one patient, turned negative on postirradiation measurements. References 1. Gragoudas ES, Goitein M, Koehler AM, et al: Proton irradiation of small choroidal malignant melanomas . Am J Ophthalmol 83:665-673, 1977. 2. Koehler AM, Schneider RJ, Sisterson JM: Range modulators for protons and heavy ions . Nucl Instrum Meth 131:437-440, 1975.Crossref 3. Koehler AM: Dosimetry of proton beams using small silicon diodes . Radiat Res 7:53-63, 1967.Crossref 4. McLean IW, Foster WD, Zimmerman LE: Prognostic factors in small malignant melanomas of choroid and ciliary body . Arch Ophthalmol 95:48-58, 1977.Crossref 5. Ferry AP: Lesions mistaken for malignant melanoma of the posterior uvea: A clinicopathologic analysis of 100 cases with ophthalmoscopically visible lesions . Arch Ophthalmol 72:463-469, 1964.Crossref 6. Shields JA, Zimmerman LE: Lesions simulating malignant melanoma of the posterior uvea . Arch Ophthalmol 89:466-471, 1973.Crossref 7. Shammas HF, Blodi FC: Prognostic factors in choroidal and ciliary body melanomas . Arch Ophthalmol 95:63-69, 1977.Crossref 8. Gass JDM: Problems in the differential diagnosis of choroidal nevi and malignant melanomas . Am J Ophthalmol 83:299-323, 1977. 9. Curtin VT, Cavender JC: Natural course of selected malignant malanomas of the choroid and ciliary body . Mod Probl Ophthalmol 12:523-527, 1974. 10. Char DH, Hogan MJ: Management of small elevated pigmented choroidal lesions . Br J Ophthalmol 61:54-58, 1977.Crossref 11. Stanford GB, Reese AB: Malignant cells in the blood of eye patients . Trans Am Acad Ophthalmol Otolaryngol 75:102-109, 1971. 12. Chisholm JF Jr: A long term follow-up on malignant melanomas of the choroid based on the Terry and John series . Am J Ophthalmol 36:61-73, 1953. 13. Mayer WD, Beitman MR: Melanosarcoma of the choroid with a long period of survival . Arch Ophthalmol 59:895-898, 1958.Crossref 14. Vannas S: On the prognosis of malignant tumors of the choroid . Klin Monatsbl Augenheilkd 135:678-690, 1959. 15. Weve HJM: Bowman lecture: On diathermy in ophthalmic practice . Trans Ophthalmol Soc UK 59:43-80, 1939. 16. Dunphy EB: Management of intraocular malignancy . Am J Ophthalmol 44:313-322, 1957. 17. Davidorf FH, Newman GH, Havener WH, et al: Conservative management of malignant melanoma: II. Transscleral diathermy as a method of treatment for malignant melanomas of the choroid . Arch Ophthalmol 83:273-280, 1970.Crossref 18. Meyer-Schwickerath G: The preservation of vision by treatment of intraocular tumors with light coagulation . Arch Ophthalmol 66:458-466, 1961.Crossref 19. Vogel MH: Treatment of malignant choroidal melanomas with photocoagulation: Evaluation of 10-year follow-up data . Am J Ophthalmol 74:1-11, 1972. 20. Stallard HB: Pigmental tumours of the eye. Surgical aspects . Proc R Soc Med 54:463-467, 1961. 21. Peyman GA, Apple DJ: Local excision of choroidal malignant melanoma: Full-thickness eye wall resection . Arch Ophthalmol 92:216-218, 1974.Crossref 22. Stallard HB: Malignant melanoblastoma of the choroid . Bibl Ophthalmol 75:16-38, 1968. 23. Long RS, Galin MA, Rotman M: Conservative treatment of intra-ocular melanomas . Trans Am Acad Ophthalmol Otolaryngol 75:84-93, 1971. 24. Newman GH, Davidorf FH, Havener WH, et al: Conservative management of malignant melanoma: I. Irradiation as a method of treatment for malignant melanoma of the choroid . Arch Ophthalmol 83:21-26, 1970.Crossref 25. Lommatzsch P: Treatment of choroidal melanomas with 106Ru-106Rh beta-ray applicators . Surv Ophthalmol 19:85-100, 1974. 26. Lommatzsch PK: Experiences in the treatment of malignant melanoma of the choroid with 106Ru-106Rh beta-ray applicators . Trans Ophthalmol Soc UK 93:119-132, 1973 27. Davidorf FH, Makley TA, Lang JR: Radiotherapy of malignant melanoma of the choroid . Trans Am Acad Ophthalmol Otolaryngol 81:849-861, 1976. 28. Stallard HB: Radiotherapy for malignant melanoma of the choroid . Br J Ophthalmol 50:147-155, 1966.Crossref 29. Lund OE: Changes in choroidal tumors after light coagulation (and diathermy coagulation): A histologic investigation of 43 cases . Arch Ophthalmol 75:458-466, 1966.Crossref 30. Hepler RS, Allen RA, Straatsma BR: Photocoagulation of choroidal melanomas: Early and late histopathologic consequences . Arch Ophthalmol 79:177-181, 1968.Crossref 31. Francois J, Hanssens M, DeLaey JJ: Recurrence of malignant melanoma of the choroid seven and eight years after light coagulation . Ophthalmologica 162:188-192, 1971.Crossref 32. Lincoff H, McLean J, Long R: The cryosurgical treatment of intraocular tumors . Am J Ophthalmol 63:389-399, 1967. 33. Bedford MA, Bedotto C, Macfaul PA: Radiation retinopathy after the application of a cobalt plaque: Report of three cases . Br J Ophthalmol 54:505-509, 1970.Crossref 34. Macfaul PA, Bedford MA: Ocular complications after therapeutic irradiation . Br J Ophthalmol 54:237-247, 1970.Crossref 35. Hayreh SS: Post-radiation retinopathy: A fluorescence fundus angiographic study . Br J Ophthalmol 54:705-714, 1970.Crossref 36. Shields JA, McDonald PR: Improvements in the diagnosis of posterior uveal melanomas . Trans Am Ophthalmol Soc 71:193-211, 1973. 37. Robertson MS, Williams JR, Schmidt RA, et al: Radiological studies of a high-energy modulated proton beam utilizing cultured mammalian cells . Cancer 35:1664-1677, 1975.Crossref 38. Tepper J, Verhey L, Goitein M, et al: In vivo determinations of RBE in a high energy modulated proton beam using normal tissue reactions and fractionated dose schedules . Int J Radiol Oncol Biol Phys 2:1115-1122, 1977.Crossref 39. Constable IJ, Goitein M, Koehler AM, et al: Small-field irradiation of monkey eyes with protons and photons . Radiat Res 65:304-314, 1976.Crossref 40. Suit HD, Goitein M: Dose-limiting tissues in relation to types and location of tumours: Implications for efforts to improve radiation dose distributions . Eur J Cancer 10:217-224, 1974.Crossref 41. Goitein M, Busse J: Immobilization error: Some theoretical considerations . Radiology 117:407-412, 1975.Crossref 42. Fletcher GH: Textbook of Radiotherapy , ed 2. Philadelphia, Lea & Febiger Publishers, 1973, pp 98-105. 43. Von Essen CF: Roentgen therapy of skin and lip carcinoma: Factors influencing success and failure . Am J Roentgenol 83:556-570, 1960. 44. Barranco SC, Romsdahl MM, Humphrey RM: The radiation response of human malignant melanoma cells grown in vitro . Cancer Res 31:830-833, 1971. 45. Dewey DL: The radiosensitivity of melanoma cells in culture . Br J Radiol 44:816-817, 1971.Crossref 46. Habermalz HJ, Fischer JJ: Radiation therapy of malignant melanoma: Experience with high individual treatment doses . Cancer 38:2258-2262, 1976.Crossref 47. Tannock IF, Hayashi S: The proliferation of capillary endothelial cells . Cancer Res 32:77-82, 1972. 48. Gillette EL, Maurer GD, Severin GA: Endothelial repair of radiation damage following beta irradiation . Radiology 116:175-177, 1975.Crossref 49. Bedford MA: The use and abuse of cobalt plaques in the treatment of choroidal malignant melanomata . Trans Ophthalmol Soc UK 93:139-143, 1973. 50. Char DH, Lonn LI, Margolis LW: Complications of cobalt plaque therapy of choroidal melanomas . Am J Ophthalmol 84:536-541, 1977. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

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American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1978.03910060217006
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Abstract

Abstract • Choroidal malignant melanomas in nine patients were treated with proton beam irradiation at the Harvard Cyclotron Laboratory, Cambridge, Mass. Each patient received five proton beam treatments in eight to ten days, totaling 4,730 to 8,570 rads at the tumor. No complications occurred during the treatment or followup period, which, at the time of this writing, ranges from one to 24 months, with an average of 12 months. No further growth of the tumor has been observed in any patient. Different signs of tumor regression have been noted. Resolution of the serous retinal detachments that accompanied some tumors is the earliest finding. Pigment changes over the surface of the tumor and adjacent pigment epithelium is a usual initial tumor response. Fluorescein angiography initially showed decreased leakage of dye; later, destruction of the tumor's vasculature and elimination of fluorescein leakage became evident. Only large choroidal vessels remained patent. Ultrasonography revealed decreased height of the tumors postirradiation, and the radioactive phosphorus (32P) uptake test, repeated in one patient, turned negative on postirradiation measurements. References 1. Gragoudas ES, Goitein M, Koehler AM, et al: Proton irradiation of small choroidal malignant melanomas . Am J Ophthalmol 83:665-673, 1977. 2. Koehler AM, Schneider RJ, Sisterson JM: Range modulators for protons and heavy ions . Nucl Instrum Meth 131:437-440, 1975.Crossref 3. Koehler AM: Dosimetry of proton beams using small silicon diodes . Radiat Res 7:53-63, 1967.Crossref 4. McLean IW, Foster WD, Zimmerman LE: Prognostic factors in small malignant melanomas of choroid and ciliary body . Arch Ophthalmol 95:48-58, 1977.Crossref 5. Ferry AP: Lesions mistaken for malignant melanoma of the posterior uvea: A clinicopathologic analysis of 100 cases with ophthalmoscopically visible lesions . Arch Ophthalmol 72:463-469, 1964.Crossref 6. Shields JA, Zimmerman LE: Lesions simulating malignant melanoma of the posterior uvea . Arch Ophthalmol 89:466-471, 1973.Crossref 7. Shammas HF, Blodi FC: Prognostic factors in choroidal and ciliary body melanomas . Arch Ophthalmol 95:63-69, 1977.Crossref 8. Gass JDM: Problems in the differential diagnosis of choroidal nevi and malignant melanomas . Am J Ophthalmol 83:299-323, 1977. 9. Curtin VT, Cavender JC: Natural course of selected malignant malanomas of the choroid and ciliary body . Mod Probl Ophthalmol 12:523-527, 1974. 10. Char DH, Hogan MJ: Management of small elevated pigmented choroidal lesions . Br J Ophthalmol 61:54-58, 1977.Crossref 11. Stanford GB, Reese AB: Malignant cells in the blood of eye patients . Trans Am Acad Ophthalmol Otolaryngol 75:102-109, 1971. 12. Chisholm JF Jr: A long term follow-up on malignant melanomas of the choroid based on the Terry and John series . Am J Ophthalmol 36:61-73, 1953. 13. Mayer WD, Beitman MR: Melanosarcoma of the choroid with a long period of survival . Arch Ophthalmol 59:895-898, 1958.Crossref 14. Vannas S: On the prognosis of malignant tumors of the choroid . Klin Monatsbl Augenheilkd 135:678-690, 1959. 15. Weve HJM: Bowman lecture: On diathermy in ophthalmic practice . Trans Ophthalmol Soc UK 59:43-80, 1939. 16. Dunphy EB: Management of intraocular malignancy . Am J Ophthalmol 44:313-322, 1957. 17. Davidorf FH, Newman GH, Havener WH, et al: Conservative management of malignant melanoma: II. Transscleral diathermy as a method of treatment for malignant melanomas of the choroid . Arch Ophthalmol 83:273-280, 1970.Crossref 18. Meyer-Schwickerath G: The preservation of vision by treatment of intraocular tumors with light coagulation . Arch Ophthalmol 66:458-466, 1961.Crossref 19. Vogel MH: Treatment of malignant choroidal melanomas with photocoagulation: Evaluation of 10-year follow-up data . Am J Ophthalmol 74:1-11, 1972. 20. Stallard HB: Pigmental tumours of the eye. Surgical aspects . Proc R Soc Med 54:463-467, 1961. 21. Peyman GA, Apple DJ: Local excision of choroidal malignant melanoma: Full-thickness eye wall resection . Arch Ophthalmol 92:216-218, 1974.Crossref 22. Stallard HB: Malignant melanoblastoma of the choroid . Bibl Ophthalmol 75:16-38, 1968. 23. Long RS, Galin MA, Rotman M: Conservative treatment of intra-ocular melanomas . Trans Am Acad Ophthalmol Otolaryngol 75:84-93, 1971. 24. Newman GH, Davidorf FH, Havener WH, et al: Conservative management of malignant melanoma: I. Irradiation as a method of treatment for malignant melanoma of the choroid . Arch Ophthalmol 83:21-26, 1970.Crossref 25. Lommatzsch P: Treatment of choroidal melanomas with 106Ru-106Rh beta-ray applicators . Surv Ophthalmol 19:85-100, 1974. 26. Lommatzsch PK: Experiences in the treatment of malignant melanoma of the choroid with 106Ru-106Rh beta-ray applicators . Trans Ophthalmol Soc UK 93:119-132, 1973 27. Davidorf FH, Makley TA, Lang JR: Radiotherapy of malignant melanoma of the choroid . Trans Am Acad Ophthalmol Otolaryngol 81:849-861, 1976. 28. Stallard HB: Radiotherapy for malignant melanoma of the choroid . Br J Ophthalmol 50:147-155, 1966.Crossref 29. Lund OE: Changes in choroidal tumors after light coagulation (and diathermy coagulation): A histologic investigation of 43 cases . Arch Ophthalmol 75:458-466, 1966.Crossref 30. Hepler RS, Allen RA, Straatsma BR: Photocoagulation of choroidal melanomas: Early and late histopathologic consequences . Arch Ophthalmol 79:177-181, 1968.Crossref 31. Francois J, Hanssens M, DeLaey JJ: Recurrence of malignant melanoma of the choroid seven and eight years after light coagulation . Ophthalmologica 162:188-192, 1971.Crossref 32. Lincoff H, McLean J, Long R: The cryosurgical treatment of intraocular tumors . Am J Ophthalmol 63:389-399, 1967. 33. Bedford MA, Bedotto C, Macfaul PA: Radiation retinopathy after the application of a cobalt plaque: Report of three cases . Br J Ophthalmol 54:505-509, 1970.Crossref 34. Macfaul PA, Bedford MA: Ocular complications after therapeutic irradiation . Br J Ophthalmol 54:237-247, 1970.Crossref 35. Hayreh SS: Post-radiation retinopathy: A fluorescence fundus angiographic study . Br J Ophthalmol 54:705-714, 1970.Crossref 36. Shields JA, McDonald PR: Improvements in the diagnosis of posterior uveal melanomas . Trans Am Ophthalmol Soc 71:193-211, 1973. 37. Robertson MS, Williams JR, Schmidt RA, et al: Radiological studies of a high-energy modulated proton beam utilizing cultured mammalian cells . Cancer 35:1664-1677, 1975.Crossref 38. Tepper J, Verhey L, Goitein M, et al: In vivo determinations of RBE in a high energy modulated proton beam using normal tissue reactions and fractionated dose schedules . Int J Radiol Oncol Biol Phys 2:1115-1122, 1977.Crossref 39. Constable IJ, Goitein M, Koehler AM, et al: Small-field irradiation of monkey eyes with protons and photons . Radiat Res 65:304-314, 1976.Crossref 40. Suit HD, Goitein M: Dose-limiting tissues in relation to types and location of tumours: Implications for efforts to improve radiation dose distributions . Eur J Cancer 10:217-224, 1974.Crossref 41. Goitein M, Busse J: Immobilization error: Some theoretical considerations . Radiology 117:407-412, 1975.Crossref 42. Fletcher GH: Textbook of Radiotherapy , ed 2. Philadelphia, Lea & Febiger Publishers, 1973, pp 98-105. 43. Von Essen CF: Roentgen therapy of skin and lip carcinoma: Factors influencing success and failure . Am J Roentgenol 83:556-570, 1960. 44. Barranco SC, Romsdahl MM, Humphrey RM: The radiation response of human malignant melanoma cells grown in vitro . Cancer Res 31:830-833, 1971. 45. Dewey DL: The radiosensitivity of melanoma cells in culture . Br J Radiol 44:816-817, 1971.Crossref 46. Habermalz HJ, Fischer JJ: Radiation therapy of malignant melanoma: Experience with high individual treatment doses . Cancer 38:2258-2262, 1976.Crossref 47. Tannock IF, Hayashi S: The proliferation of capillary endothelial cells . Cancer Res 32:77-82, 1972. 48. Gillette EL, Maurer GD, Severin GA: Endothelial repair of radiation damage following beta irradiation . Radiology 116:175-177, 1975.Crossref 49. Bedford MA: The use and abuse of cobalt plaques in the treatment of choroidal malignant melanomata . Trans Ophthalmol Soc UK 93:139-143, 1973. 50. Char DH, Lonn LI, Margolis LW: Complications of cobalt plaque therapy of choroidal melanomas . Am J Ophthalmol 84:536-541, 1977.

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Sep 1, 1978

References