Side effects of proton beam therapy of choroidal melanoma in dependence of the dose to the optic disc and the irradiated length of the optic nerve

Purpose To analyze the impact of the dose to the optic disc and the irradiated length of the optic nerve on radiation-induced optic neuropathy, radiation-induced retinopathy, iris neovascularization, secondary glaucoma, enucleation, and local tumor control after proton beam therapy (PBT) of choroida...

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Bibliographic Details
Published in:Graefe's archive for clinical and experimental ophthalmology 2020-11, Vol.258 (11), p.2523-2533
Main Authors: Riechardt, Aline I., Stroux, Andrea, Seibel, Ira, Heufelder, Jens, Zeitz, Oliver, Böhmer, Dirk, Joussen, Antonia M., Gollrad, Johannes
Format: Article
Language:English
Subjects:
Cobalt
Enucleation
Glaucoma
Iris
Medicine
Medicine & Public Health
Melanoma
Multivariate analysis
Oncology
Ophthalmology
Optic nerve
Optic neuropathy
Regression analysis
Retinopathy
Risk factors
Vascularization
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Summary:Purpose To analyze the impact of the dose to the optic disc and the irradiated length of the optic nerve on radiation-induced optic neuropathy, radiation-induced retinopathy, iris neovascularization, secondary glaucoma, enucleation, and local tumor control after proton beam therapy (PBT) of choroidal melanoma. Method Retrospective analysis of 1129 patients, who received primary PBT for the treatment of choroidal melanoma with a dose of 60 cobalt gray equivalents (CGE) between 1998 and 2013 at the Helmholtz-Zentrum Berlin, Germany. Kaplan-Meier curves and logrank test have been used for time-to-event analyses. Adjustment for potential confounders was done using multiple Cox regression models with forward and backward selection. Results We found a significant correlation between the irradiated length of the optic nerve and the dose to the optic disc (correlation coefficient, 0.93). Multivariate Cox regression revealed the dose to the optic disc as an independent predictive risk factor for the development of radiation-induced optic neuropathy ( p < 0.001, HR 1.023, 95 CI 1.016–1.029), iris neovascularization ( p < 0.001, HR 1.013, 95% CI 1.008–1.019), secondary glaucoma ( p < 0.001, HR 1.017, 95% CI: 1.011-1.023) and enucleation ( p < 0.001, HR 1.037, 95% CI 1.020-1.053). The irradiated length of the optic nerve was not a statistically independent predictive risk factor in multivariate analysis. Conclusion Our data implicate the predominance of the dose to the optic disc over the irradiated length of the optic nerve regarding radiation-induced optic neuropathy, iris neovascularization, secondary glaucoma, and enucleation.
ISSN:0721-832X
1435-702X
DOI:10.1007/s00417-020-04780-y