Outcomes of treatment with stereotactic radiosurgery or proton beam therapy for choroidal melanoma MJ Sikuade 1 , S Salvi 1 , PA Rundle 1 , DG Errington 2 , A Kacperek 2 and IG Rennie 1 Abstract Aim To present our experience of the use of stereotactic radiosurgery and proton beam therapy to treat posterior uveal melanoma over a 10 year period. Methods and materials Case notes of patients treated with stereotactic radiosurgery (SRS), or Proton beam therapy (PBT) for posterior uveal melanoma were reviewed. Data collected included visual acuity at presentation and final review, local control rates, globe retention and complications. We analysed post-operative visual outcomes and if visual outcomes varied with proximity to the optic nerve or fovea. Results 191 patients were included in the study; 85 and 106 patients received Stereotactic radiosurgery and Proton beam therapy, respectively. Mean follow up period was 39 months in the SRS group and 34 months in the PBT group. Both treatments achieved excellent local control rates with eye retention in 98% of the SRS group and 95% in the PBT group. The stereotactic radiosurgery group showed a poorer visual prognosis with 65% losing more than 3 lines of Snellen acuity compared to 45% in the PBT group. 33% of the SRS group and 54% of proton beam patients had a visual acuity of 6/60 or better. Conclusions Stereotactic radiosurgery and proton beam therapy are effective treatments for larger choroidal melanomas or tumours unsuitable for plaque radiotherapy. Our results suggest that patients treated with proton beam therapy retain better vision post- operatively; however, possible confounding factors include age, tumour location and systemic co-morbidities. These factors as well as the patient’s preference should be considered when deciding between these two therapies. Eye (2015) 29, 1194–1198; doi:10.1038/eye.2015.109; published online, 10 July 2015 Introduction The primary aim of treatment for uveal melanoma is tumour destruction. Secondary to this is preservation of the eye and retention or restoration of visual function. To this end, a number of treatment options exist including plaque brachytherapy, 1,2 proton beam irradiation 3,4 stereotactic radiosurgery, 5 local resection 6 and to a lesser extent transpupillary thermotherapy 7 or photodynamic therapy 8 as well as of course primary enucleation. The treatment modality used is dependent on several factors including size and location of the tumour, proximity to the optic disc or fovea, suitability for surgery and patient choice. Since the results of the COMS study which suggested no difference in mortality for patients with medium-sized melanomas treated with either brachytherapy or enucleation, 2 eye- conserving therapies have been used in the majority of patients. Treatment of larger tumours as well as tumours in close proximity to the optic nerve is more challenging as accurate placement of a plaque to cover the entire tumour can be technically difficult. Other eye sparing radiation treatments such as proton beam therapy (PBT) and stereotactic radiosurgery (SRS) do not suffer from these limitations and have been used for many years to treat these more challenging melanomas. As both of these treatments options are available at our national ocular oncology centre (in conjunction with the Douglas Cyclotron Unit at the Clatterbridge Oncology Centre), this study was designed to compare outcomes in our patient cohort over a 10-year period. 1 Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, Sheffield, UK 2 Department of Oncology, Douglas Cyclotron, Clatterbridge Cancer Centre, Wirral, UK Correspondence: MJ Sikuade, Department of Ophthalmology, Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK Tel: 0114 27 13619; Fax: 0114 271 2902. E-mail: mjsikuade@ doctors.net.uk Received: 5 March 2015 Accepted in revised form: 30 April 2015 Published online: 10 July 2015 Presented as a poster at the North of England Ophthalmological Society Centenary Conference. CLINICAL STUDY Eye (2015) 29, 1194–1198 © 2015 Macmillan Publishers Limited All rights reserved 0950-222X/15 www.nature.com/eye