A 15-year experiment in the treatment of posterior uveal melanomas with radiotherapy

Purpose: to describe methods and results of treatment of uveal melanomas with radiotherapy. To recall the progress in means and conceptions of conservative treatment for eye uveal tumours, and the mandatory and adequate collaboration between ophthalmologists and radiotherapists. Patients and methods: two hundred and nineteen patients were treated with ruthenium 106 between 1983 and 1995, and 226 with protons between 1991 and 1998 at the Croix Rousse Hospital University Eye Clinic in Lyon. Results: five-year survival rates were identical in both series (83.2% and 81%). In both series, largest tumour diameters had an identical spread (two-thirds of tumours had a largest tumour diameter inferior or equal to 10 mm). Complications were different in both series, with less radiation maculo-pathic in the ruthenium (33%) than in the proton one (42%), but fewer recurrences (7%) in the proton than in the ruthenium series (16%). Conclusion: the only statistically significant observation (univariate analysis) is the direct relation between severity of vital prognosis, whatever the irradiation technique used, and the increase of the largest tumour diameter. No conclusion could currently lead to choosing one irradiation technique over another one, as far as vital prognosis is concerned. Nevertheless, the diversification of treatment methods allows choosing proton beam therapy for posterior tumours and brachytherapy for anterior tumours. (author)