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. 1997 Sep;81(9):748–754. doi: 10.1136/bjo.81.9.748

Predictive factors for the development of rubeosis following proton beam radiotherapy for uveal melanoma

A Foss 1, I Whelehan 1, J Hungerford 1, D Anderson 1, R Errington 1, A Kacperek 1, M Restori 1, J Kongerud 1, M Sheen 1
PMCID: PMC1722306  PMID: 9422926

Abstract

AIMS/BACKGROUND—Proton beam radiotherapy can effectively treat primary uveal melanomas of any size. Some patients, however, develop adverse late effects following treatment and the purpose of this study was to determine which factors give rise to a poor local outcome.
METHODS—The hospital records from a first cohort of 127 patients treated by protons from 1989 to 1992 were reviewed retrospectively. The presence of rubeosis was selected as a measure of significant ocular damage. Split file analysis was performed with 73 cases forming a test group with the remaining 54 cases acting as a validation group.
RESULTS—Large tumour size and the presence of retinal detachment were significant, independent risk factors for developing rubeosis for both the test and validation groups. These factors also predicted subsequent enucleation for uncontrolled ocular pain. Patients with tumours too large to plaque and with an associated retinal detachment had a 90% chance of developing rubeosis within 4 years of proton beam radiotherapy.
CONCLUSIONS—Patients with a uveal melanoma too large for plaque therapy and an associated retinal detachment run a very high risk of developing rubeosis after proton beam radiotherapy and one third of individuals developing rubeosis required enucleation for pain even if local tumour control was satisfactory.



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Figure 1  .

Figure 1  

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Kaplan-Meier curves showing the effect of size on the subsequent development of rubeosis for the merged groups. Small refers to tumours smaller enough to be plaqueable and large means that they were too large for brachytherapy to be an option.

Figure 2  .

Figure 2  

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Kaplan-Meier curves showing the effect of the presence or absence of an associated retinal detachment for the subsequent development of rubeosis for the merged groups.

Figure 3  .

Figure 3  

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Kaplan-Meier curves showing the predictive effect of the 2 point scoring system for the subsequent development of rubeosis for the merged groups.

Figure 4  .

Figure 4  

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Kaplan-Meier curves showing the predictive effect of the 2 point scoring system for subsequent enucleation for morbidity for the merged groups.

Figure 5  .

Figure 5  

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Kaplan-Meier curves showing the predictive effect of the 2 point scoring system for subsequent tumour related death for the merged groups.

Figure 6  .

Figure 6  

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A clinical algorithm summarising how we propose uveal melanoma should be treated. The numbers refer to how the cases described in this paper fit into the proposed algorithm.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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