30 years of ocular proton therapy, the Nice view 30 ans de protontherapie nic , oise

Purpose. - Radiotherapy with protons (PT) is a standard treatment of ocular tumors. It achieves excellent tumor control, limited toxicities, and the preservation of important functional outcomes, such as vision. Although PT may appear as one homogenous technique, it can be performed using dedicated ocular passive scattering PT or, increasingly, Pencil Beam Scanning (PBS), both with various degrees of patient -oriented customization. Materaial and methods. - MEDICYC PT facility of Nice are detailed with respect to their technical, dosi-metric, microdosimetric and radiobiological, patient and tumor-customization process of PT planning and delivery that are key. 6684 patients have been treated for ocular tumors (1991-2020). Machine characteristics (accelerator, beam line, beam monitoring) allow efficient proton extraction, high dose rate, sharp lateral and distal penumbrae, and limited stray radiation in comparison to beam energy reduction and subsequent straggling with high-energy PBS PT. Patient preparation before PT includes cus-tomized setup and image-guidance, CT-based planning, and ocular PT software modelling of the patient eye with integration of beam modifiers. Clinical reports have shown excellent tumor control rates (similar to 95%), vision preservation and limited toxicity rates (papillopathy, retinopathy, neovascular glaucoma, dry eye, madarosis, cataract). Results. - Although demanding, dedicated ocular PT has proven its efficiency in achieving excellent tumor control, OAR sparing and patient radioprotection. It is therefore worth adaptations of the equipments and practice. Conclusions. - Some of these adaptations can be transferred to other PT centers and should be acknowl-edeged when using non-PT options.(c) 2022 Societe franc , aise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Automated summary

This article introduces the application of proton therapy in the treatment of ocular tumors, including technical aspects, planning, and delivery processes. Clinical studies have shown that proton therapy can achieve excellent tumor control and functional preservation, with limited toxicities.