Purpose: Peripapillary choroidal melanoma provides a unique challenge; proximity to visually important structures, such as the optic disc and fovea, confers a high risk for the development of maculopathy and optic neuropathy, leading to poorer visual outcomes with most forms of radiotherapy. Ocular proton therapy (OPT) requires an aperture to shape the beam to the tumour. An aperture ‘notch’ may minimise damage to the optic disc and/or the fovea. This study aims to explore if there are any additional advantages to incorporating a notch over the optic nerve beam area. Design: Retrospective audit (cohort study). Participants: Participants included eighty-three patients treated at Liverpool with proton beam therapy from January 2012 to March 2020 for their peripapillary choroidal melanoma. All had a minimum of two and a half years of follow-up vision data; this was to ensure there was enough visual acuity assessment data to perform sufficient analysis. Patients excluded had choroidal melanoma situated over 3 mm from the optic disc, as these were unlikely to have an aperture notch. Methods: A retrospective audit was undertaken in accordance with the Declaration of Helsinki, and registered with the Royal Liverpool Hospitals audit department (audit reference number: Ophth/SE/2024-25/25). Data was collated from the Liverpool Ocular Oncology database, clinic letters and the individual proton beam 3D plans. Robust statistical analysis using a mixed effects model was used to explore associations between notched beams and vision loss and complications. Main Outcome Measures: The primary outcome measure is visual acuity loss post-proton beam therapy. Secondary outcome measures were enucleation and other complication rates. Results: Analysis shows that at 10 years post-OPT, there would be an expected 0.058 (p= 0.077) logMAR of vision saved using a notch for the optic disc compared to no notch (normal apertures); this is considered clinically significant. This cohort also loses vision at a slower rate than other cases. No other predictors were found to be statistically significant for loss of vision, and notched beams showed no advantage in reducing rates of complications. Conclusions: There is some evidence of a trend that utilising a notch for optic disc does show long-term vision benefit; it demonstrates a clinically significant benefit in patients with peripapillary choroidal melanoma.
目的：视盘周围脉络膜黑色素瘤的治疗面临独特挑战；其毗邻视盘和黄斑等重要视觉结构，导致发生黄斑病变和视神经病变的风险较高，大多数放射治疗方式均会导致较差的视力预后。眼质子治疗（OPT）需要使用孔径来将质子束塑形至肿瘤区域。在孔径上设置"凹口"可能有助于最大限度地减少对视盘和/或黄斑的损伤。本研究旨在探讨在视神经束区域设置凹口是否具有额外优势。设计：回顾性审计（队列研究）。参与者：纳入2012年1月至2020年3月在利物浦接受质子束治疗的83例视盘周围脉络膜黑色素瘤患者。所有患者均拥有至少两年半的随访视力数据，以确保有足够的视力评估数据进行充分分析。排除标准为脉络膜黑色素瘤距视盘超过3毫米的患者，因其治疗计划不太可能使用孔径凹口。方法：根据《赫尔辛基宣言》进行回顾性审计，并在皇家利物浦医院审计部门注册（审计编号：Ophth/SE/2024-25/25）。数据来源于利物浦眼肿瘤学数据库、临床信件及个体化质子束三维治疗计划。采用混合效应模型进行稳健的统计分析，以探讨凹口束与视力丧失及并发症之间的关联。主要结局指标：主要结局指标为质子束治疗后视力丧失情况。次要结局指标包括眼球摘除率及其他并发症发生率。结果：分析显示，OPT术后10年，与未使用凹口（常规孔径）相比，为视盘设置凹口预计可保留0.058 logMAR的视力（p=0.077），该差异被认为具有临床意义。此外，该队列患者的视力下降速度也较其他病例更慢。未发现其他预测因子与视力丧失具有统计学显著性关联，且凹口束在降低并发症发生率方面未显示优势。结论：有证据表明，为视盘设置凹口可能带来长期视力获益的趋势；对视盘周围脉络膜黑色素瘤患者而言，该技术显示出具有临床意义的益处。
Outcomes Following Treatment with Notched Proton Beams for Peripapillary Choroidal Melanomas
肿瘤(癌症)患者之家