Dry Eye Syndrome After Proton Therapy of Ocular Melanomas

Purpose: To investigate whether proton therapy (PT) performs safely in superotemporal melanomas, in terms of risk of dry-eye syndrome (DES). Methods and Materials: Tumor location, DES grade, and dose to ocular structures were analyzed in patients undergoing PT (2005-2015) with 52Gy (prescribed dose, not accounting for biologic effectiveness correction of 1.1). Prognostic factors of DES and severe DES (sDES, grades 2-3) were determined with Cox proportional hazard models. Visual acuity deterioration and enucleation rates were compared by sDES and tumor locations. Results: Median follow-upwas 44 months (interquartile range, 18-60months). Of 853 patients (mean age, 64 years), 30.5% had temporal and 11.4% superotemporal tumors. Five year incidence ofDES and sDES was 23.0%(95% confidence interval [CI] 19.0%-27.7%) and 10.9% (95% CI 8.2%-14.4%), respectively. Multivariable analysis showed a higher risk for sDES in superotemporal (hazard ratio [HR] 5.82, 95% CI 2.72-12.45) and temporal tumors (HR2.63, 95% CI 1.28-5.42), age >= 70 years (HR1.90, 95% CI 1.09-3.32), distance to optic disk >= 5 mm (HR 2.71, 95% CI 1.52-4.84), >= 35% of retina receiving 12 Gy (HR 2.98, 95% CI 1.54-5.77), and eyelid rimirradiation (HR2.68, 95% CI 1.49-4.80). The same risk factors were found for DES. Visual acuity deteriorated more in patients with sDES (0.86 +/- 1.10 vs 0.64 +/- 0.98 logMAR, PZ. 034) but not between superotemporal/temporal and other locations (PZ. 890). Enucleation rates were independent of sDES (PZ. 707) and tumor locations (PZ. 729). Conclusions: Severe DES was more frequent in superotemporal/temporal melanomas. Incidence of vision deterioration and enucleation was no higher in patients with superotem poral melanoma than in patients with tumors in other locations. Tumor location should not contraindicate PT. (C) 2017 Elsevier Inc. All rights reserved.