Background/Objectives:Uveal melanoma is the most common primary intraocular malignancy in adults. Treatment options for localized, early-stage disease include enucleation, brachytherapy, and proton beam therapy. This review aims to evaluate the role of proton therapy in the definitive management of uveal melanoma, focusing on its physics, radiobiology, treatment techniques, and associated outcomes.Methods:This narrative review synthesizes current literature on proton therapy for uveal melanoma, emphasizing case selection, treatment efficacy, and side effects.Results:Proton therapy offers significant advantages for thicker uveal melanomas (over 8 mm) due to its unique physical properties, including a rapid dose fall-off that protects critical structures like the retina and optic nerve. Proton therapy may have benefits in tumor control for ocular melanomas given its increased relative biological effectiveness relative to photon therapy for these typically more radioresistant melanomas. Proton therapy may also hold special value for uveal melanomas in close proximity to the optic nerve, as patients are at high risk of visual toxicities with brachytherapy. The review discusses the efficacy of proton therapy across small, medium, and large tumors, along with strategies for improving patient survival through combined systemic therapy. Additionally, the potential of ocular reirradiation with proton therapy is addressed.Conclusions:Proton therapy is an effective treatment for uveal melanoma. It offers advantages over brachytherapy for large tumors, tumors that are close to the optic nerve or insertion of extra-ocular muscles.
背景/目的：葡萄膜黑色素瘤是成人最常见的原发性眼内恶性肿瘤。针对局限性早期病变的治疗方案包括眼球摘除术、近距离放射治疗和质子束治疗。本综述旨在评估质子治疗在葡萄膜黑色素瘤根治性治疗中的作用，重点关注其物理学特性、放射生物学原理、治疗技术及相关临床结果。 方法：本叙述性综述综合了当前关于质子治疗葡萄膜黑色素瘤的文献，着重分析病例选择标准、治疗效果及副作用。 结果：质子治疗因其独特的物理特性（包括剂量骤降效应能保护视网膜和视神经等关键结构），对厚度超过8毫米的葡萄膜黑色素瘤具有显著优势。鉴于葡萄膜黑色素瘤通常具有较高放射抗性，质子治疗相对于光子治疗具有更高的相对生物效应，可能在肿瘤控制方面更具优势。对于邻近视神经的葡萄膜黑色素瘤，质子治疗尤其具有特殊价值，因为此类患者接受近距离放射治疗时发生视力毒性的风险较高。本综述探讨了质子治疗对不同大小肿瘤（小型、中型、大型）的疗效，以及通过联合全身治疗提高患者生存率的策略，同时分析了质子治疗在眼部再程放疗中的应用潜力。 结论：质子治疗是葡萄膜黑色素瘤的有效治疗手段。对于大型肿瘤、邻近视神经或眼外肌附着点的肿瘤，质子治疗较近距离放射治疗更具优势。
肿瘤(癌症)患者之家