Common Melanoma treatments
Traditionally, the common treatment of uveal melanoma has been enucleation. Plate brachytherapy iodine and Ruthenium was subsequently introduced, since they allow the conservation of the eye and the visual function, establishing as the valid option in most cases for the treatment of this lesion.
The application of brachytherapy in this case, however, has limitations. A team of trained ophthalmologists is needed, the patient must undergo one or more invasive operations, and the intervention is not free of adverse effects.
The placement of radioactive plates is very complicated in case of very small tumors and when its posterior margin extends to the fovea or optical nerve. In addition, in tumors more than 5 mm thick, brachytherapy does not penetrate enough (not giving the prescribed dose), and is not suitable when causing complications such as optical neuropathy.
Treatments based on directed systemic therapy are also being investigated for this type of tumors.
Protons therapy of this pathology, in addition to allowing ocular conservation and visual function, also allows to deposit high doses, in hypofractioning protocols, in small volumes, avoiding risk structures such as the optical disc or the macula. The retina and sclera will receive reduced and tolerable doses.
With protonopia, melanomas of more volume (up to 25 mm) can be treated without performing invasive operations.
1.1 global results
In the reviews analyzed in this work, we have comparing the different results obtained with proton therapy with those obtained in other therapies, such as brachytherapy, enucleation and conventional radiotherapy with photons with.
As for global mortality and that related to the disease there are no differences between enucleation and protonopia.
The local recurrence rate in patients treated with brachytherapy with iodine-125 and with protons is comparable. However, it is less than in patients treated with Ruthenio-126.
Among photons and protons, there are no differences in ocular preservation or survival. As for toxicity, protonopia seems to have a lower probability of neovascular glaucoma and secondary enucleation than conventional radiotherapy with photons.
In protons therapy, a lower vision loss is shown after administering 50 CGE (Cobalt Gray equals).
1.2 conclusions
It seems that protonopia presents similar results in terms of efficacy, compared to the rest of the therapies already mentioned. However, it has advantages over the preservation of the view.
In a report published in 2012, the American Society for Radiation Oncology (Astro) includes uveal melanoma, especially when it is very bulky, as a pathology that benefits from the use of protonopia.
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