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Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology 8/2016

26.04.2016 | Oncology

Cataract development in patients treated with proton beam therapy for uveal melanoma

verfasst von: Ira Seibel, Dino Cordini, Annette Hager, Aline I. Riechardt, Matus Rehak, Alexander Böker, Dirk Böhmer, Jens Heufelder, Antonia M. Joussen

Erschienen in: Graefe's Archive for Clinical and Experimental Ophthalmology | Ausgabe 8/2016

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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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Metadaten
Titel
Cataract development in patients treated with proton beam therapy for uveal melanoma
verfasst von
Ira Seibel
Dino Cordini
Annette Hager
Aline I. Riechardt
Matus Rehak
Alexander Böker
Dirk Böhmer
Jens Heufelder
Antonia M. Joussen
Publikationsdatum
26.04.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Graefe's Archive for Clinical and Experimental Ophthalmology / Ausgabe 8/2016
Print ISSN: 0721-832X
Elektronische ISSN: 1435-702X
DOI
https://doi.org/10.1007/s00417-016-3356-4

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